Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

Results: Patients' ages range from 3 to 69 years, 66.2% of them between
21-40 years and a male - female ratio of 1:2. 452(85.3%) presented with
a history of cough. There were more radiographic changes in the left lung
(53.5%) with varying opacities and cystic/cavitatory changes most common in
the right upper and the left middle zones. 86 (16.2%) mostly younger patients
had cardiomegaly Pulmonary tuberculosis was reported in 144(27.1%)
patients and atypical pneumonic consolidation in 53(10%), while 24 had hilar/
mediastinal lymphadenopaathy
Conclusions: No obvious chest radiographic pattern was seen nevertheless
pulmonary tuberculosis is the commonest chest radiographic abnormality in
HIV/AIDS. The importance of chest radiograph cannot be overemphasized.
MOPEO188
Outcomes of DOTS among HIV/TB Co-infected.
persons in a community and home-based care and
support project in Pune, India
J. Gogial, D. Vicharel, P. Deshpande2, M. Toshniwal2, S. Mukherjee',
H. Alderfer3. 'PCI, HIV/AIDS, New Delhi, India, 2PCI, HIV/AIDS, Pune, India,
3PCI, New Delhi, India
Issues: The HIV/AIDS epidemic has led to a rise in tuberculosis (TB) incidence
and an epidemic of co-infection. In January 2006, Project Concern International
(PCI)/India conducted a study to measure the outcomes of Directly Observed
Treatment Short-Course (DOTS) implemented as part of its PATHWAY project, a
community and home-based care (CHBC) project in Pune. PCI coordinated with
the government (GO) on DOTS in HIV/TB co-infection, provided through the
Revised National TB Control Program (RNTCP). Suspected TB cases are referred
by outreach workers to RNTCP centers for diagnosis, and RNTCP centers supply
TB drugs to PATHWAY DOTS centers.
Description: A retrospective study was conducted of 6 HIV/TB co-infected
persons enrolled in PATHWAY since December 2001. Data were abstracted
from TB patient treatment cards using standard RNTCP outcome definitions
(e.g., degree of co-infection, default, relapse, and cure). Structured interviews
were conducted with district GO authorities to determine their views on the
partnership between RNTCP and PCI and its outcomes.
Lessons learned: Of the HIV/TB co-infected persons studied, 75% had
pulmonary TB and 25% had extra-pulmonary TB. Sixty-five percent belonged
to the sputum positive group and 35% were sputum negative. Eightysix percent belonged to category I (lesser degree of co-infection), 14% to
category II. Seventy-two percent completed the treatment, 72% were cured,
25% died, 3a defaulted, and 5%a relapsed. Interviews revealed that treatment
outcomes were positively influenced by regular non-governmental organization
(NGO) staff training; regular monitoring by RNTCP; prompt referral; and open
feedback by NGO staff.
Recommendations: GO-NGO partnership in HIV/TB program coordination
can positively influence early detection and initiation of DOTS for people living
with HIV/AIDS. Results support the theory that integration of more than oneprogram, e.g. CHBC for HIV and DOTS for TB, makes programs more efficient
and can result in more positive treatment outcomes.
M0PE0189
Improving TB/HIV co-infection services in the
Russian Federation
V. Boguslavsky, Quality Assurance Project. University Research Co., LLC,
Moscow Office, Russia, Bethesda, United States
Issues: The HIV/AIDS epidemic in Russia is among the fastest growing.
The incidence of tuberculosis has doubled over the past decade and remains
very high. The existing vertical systems of HIV/AIDS and TB care have little
coordination with each other and are inadequate to respond to the dual
epidemic.
Description: In 2004, the USAID-funded Quality Assurance Project (QAP) of
URC and the Health Partnerships Program of the American International Health
Alliance began joint work in four Russian cities (St. Petersburg, Engels, Togliatti,
Orenburg) to develop an organized model for delivery of treatment, care and
support to PLWHA. TB/HIV detection and treatment was identified as one of
the main project components along with patient access and retention, care
coordination, and patient clinical management. An improvement collaborative
approach is being utilized to engage -interdisciplinary teams of providers
drawn from regional AIDS Centers, city TB and narcological dispensaries,
polyclinics, social service organizations and NGOs in each city to implement
improvements of services. Leaders of participating organizations have created
project coordination committees in each region to facilitate the decision making
toward institutionalization of improved services.
Lessons learned: Teams began testing changes in January 2005. Within a year
the following tangible improvements were realized: regulatory documents on
coordination of TB and HIV/AIDS services were adopted by health authorities
in each city; a 30 percent increase in numbers of HIV positives screened for TB
has been demonstrated in Engels; the coverage of HIV positives with counseling
for TB/HIV co-infection in Togliatti was raised from 0 to 280/; the TB preventive

treatment in patients with HIV was initiated.
Recommendations: While the concept of interdisciplinary collaboration is not
new, the improvement collaborative has operationalized in a purpose-oriented
way that makes is effective for countries where services are fragmented due to
separate budgeting and controlled by the national governments.

MOPE0190
Risk of active tuberculosis (TB) and prognostic
significance of tuberculosis among TAHOD patients
J. Zhou', J. Elliott', R. Ditangco2, S. Pujari3, P.L. Lim4, S. Kiertiburanakul5,
T. Parwati Merati6, N. Kumarasamy7, M. Law', on behalf of TREAT Asia HIV
Observational Database. 'National Centre in HIV Epidemiology and Clinical
Research, The University of New South Wales, Sydney, Australia, 2Research
Institute for Tropical Medicine, Manila, Philippines, 3Ruby Hall Clinics, Pune,
India, 4Tan Tock Seng Hospital, Singapore, Singapore, 5Ramathibodi Hospital,
Mahidol University, Bangkok, Thailand, 'Infectious Diseases Section, School
of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia, 7YRG
Centre for AIDS Research and Education, Y.R. Gaitonde Medical and Research
Foundation, Chennai, India
Background: We aimed to assess factors associated with TB diagnosis, and
the prognostic significance of TB in overall survival, using data from the TREAT
Asia HIV Observational Database (TAHOD).
Methods: The risk of TB diagnosis after entry to TAHOD was assessed in
patients with prospective follow-up no previous TB diagnosis. To assess the
impact of background TB prevalence rate on the risk of TB diagnosis, sites
were grouped into high and low/intermediate TB burden by WHO guidelines.
Baseline TB and incident TB were included as time-dependent variables in
assessing overall survival. Diagnosis of CDC category B disease, single or
multiple diagnoses of AIDS other than TB and antiretroviral treatment were
also included as time-dependent variables.
Results: Among the 2218 patients with prospective follow-up, 501 (22.6%)
were diagnosed with TB prior to entry to TAHOD. Baseline CD4 counts were
higher among patients with no prior AIDS (Median 313 cells/pL), than those of
patients with prior AIDS but not TB (243) and patients with TB (212, p<0.001).
During follow-up 33 patients developed TB (1.44 per 100 person years [PYs]).
A higher CD4 count at baseline, receiving antiretroviral treatment and coming
from low/intermediate TB countries were associated with a lower risk of TB
diagnosis. A total of 88 patients died during 3025 years of follow-up (2.77 per
100 PYs). In multivariate analysis, compared with patients with CDC category A
disease, mortality was raised in patients with CDC category B disease (hazard
ratio, HR 1.80, p=0.191), TB diagnosis (HR 1.66, p=0.202), other single
AIDS diagnosis (HR2.85, p=0.002), multiple other AIDS diagnoses (HR 4.51,
p<0.001) and TB and AIDS diagnosis (HR 3.40, p<0.001).
Conclusions: Although the overall rate of TB was higher than that seen in
western countries, the risk factors identified were similar. In TAHOD, patients
with TB only had better survival than patients with other AIDS illnesses.
MOPEO1I
Immunological response to anti-tuberculosis
treatment in HIV-TB co-infected patients
P. Chandrasekaran, S. Swaminathan, V. Perumal, P.A. Menon, N. Gopalan,
P. Chinnaiyan, S. Subramanian. Tuberculosis Research Centre (Indian Council
of Medical Research), HIV/AIDS, Chennai, India
Background: Tuberculosis is known to increase the viral load as well as systemic
immune activation markers in patients infected with human immunodeficiency
virus (HIV). Our aim was to study the impact of tuberculosis on immune status
of patients with HIV and relate it to their initial CD4 cell counts.
Methods: HIV patients with newly diagnosed tuberculosis attending
Tuberculosis Research centre, Chennai and Madurai units, were treated with
standard short-course intermittent anti-Tuberculosis (ATT) regimens. None of
them were on antiretroviral therapy. CD4 cell counts were measured at baseline
and at the time of completion of ATT. Patients were classified into three immune
categories and the changes in CD4 count studied by trend chi-square test.
Results: CD4 cell counts were available for 208 patients both at baseline and at
end of ATT. 79% were males with the mean age being 32.1 years. The median
CD4 cell count at baseline was 168 cells/mm3 (range: 5-960 cells/mm3) and
at the end of treatment was 184 cells/mm3 (range: 6-874 cells/mm3). Immune
deterioration was more pronounced in patients with less advanced HIV disease
with CD4 counts > 250 cells/mm3 (p < 0.01).
C04 celcounts Number of CD4cel.esone.t.ndoftraten
beoeAT patients elr sneam en ftram t

Moda

Same
Deteriorated status
status 48%
11~10 48%

Improved
41%

< 150 cell/ mm3 95
150-250 cells/mm3 48
> 250 cells/ mm3 65

35%
54%

31% 33%
23% 23%

Deteriorated: a decrease of > 50 cells from baseline value Improved: An
increase of > 50 cells from baseline value
Conclusions: Tuberculosis causes a further deterioration of immune status
in HIV-infected patients; this appears to be more pronounced in patients with
higher CD4 cell counts (> 250 cells/mm3). These findings underscore the
importance of TB prevention as well as the increased need for antiretroviral
drugs once TB develops.

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1