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P645 Diverse dermatologic manifestations in HIV-infected patients after highly active antiretroviral therapy
S152
17th ECCMID / 25th ICC, Posters
Conclusion: The proportion of liver-related deaths and particularly hepatocellular carcinoma increased between 2000 and 2005 in HIVinfected adults, while the proportion of AIDS related death has decreased. This justifies a more aggressive treatment of viral hepatitis C and B, the prevention of alcohol consumption, and an early and regular screening for hepatocellular carcinoma in case of cirrhosis.
No. of deaths with known status for HBV and HCV Death from liver disease among which Hepatocellular carcinoma Main cause of liver disease HCV HBV HCV + HBV Alcohol Other Median age Median CD4 cell count/mm3
2000
2005
822
831
110 (13%) 17 (15%)
125 (15%) 31 (25%)
72 (65%) 14 (13%) 16 8 – 41 90
90 (72%) 16 (13%) 6 8 5 46 165
P644 Longitudinal evaluation of the prevalence of insulin resistance in a cohort of HIV vertically-infected children and adolescents R. Rosso, A. Parodi, E. Repetto, C. Torrisi, C. Bernardini, F. Ginocchio, M.P. Sormani, M. Vignolo, C. Viscoli (Genoa, IT) Background: To assess the rate of progression insulin resistance (IR) and the associated metabolic disturbances over a 1-year period in HIV vertically-infected children and adolescent and to assess risk factors associated. Methods: 48 children (age range 6−22 years; 21 F, 27 males) were followed over a mean period of 14 months (range 5−27). Fasting lipids and glucose profile were measured in all children. Therapy and disease history, presence of lipodystrophy, possible co-infections, axiological features were recorded at the baseline and at the end of the follow-up. Results: At baseline, fasting insulin and HOMA-IR were significantly higher in HIV-infected patients than in healthy children and adolescents (p < 0.001). Therapy duration (r = 0.281, p < 0.05), triglycerides (r = 0.286, p < 0.05), age (r = 0.299, p < 0.05), BMI (r = 0.485, p < 0.001) were significant predictor variables of IR, expressed as HOMA-IR >3. At baseline and at the end of follow-up, 36% vs. 29% of pts showed IR; and 32% vs. 33% showed dyslipidaemia (high cholesterol, or triglycerides or both), respectively. The proportion of patients presenting lipodystrophy remained stable (16.6%). Prospective follow-up showed no progression at all over 1 years, in particular the number of patients with IR remained the same but the level of mean HOMA-IR increased slightly (2.6±1.6 vs 3.8±8.1), showing no correlation with therapy duration as a whole and particularly with PI-based HAART. HAART, defined as association of 3 antiretroviral drugs, seems not to be related with a worsening in IR. Sex, birth weight, HCV-infection have no relation with IR, while lipodistrophy, Tanner stage IV-V of puberty, hyper triglyceridaemia seem to be predictor variables of IR both at baseline and at the end of followup (p < 0.05). Conclusions: In HIV-infected children IR and other metabolic complications, such lipodystrophy are more likely to develop after midpuberty. Progression of disorders of glucose metabolism seems to be slow but, regarding their enlarged life expectancy, efforts to prevent the development of such complications should be targeted toward HIVinfected children with an at least annual (using fasting glycaemia and insulin) follow-up.
P645 Diverse dermatologic manifestations in HIV-infected patients after highly active antiretroviral therapy K. Jutivorakool, P. Plussind, H. Choengwiwatkit, J. Waiwarawut (Chonburi, TH) Objective: Highly active antiretroviral therapy (HAART) has increased survival in HIV patients. However, there are few studies on skin manifestations in HIV-infected patients after HAART with somewhat conflicting data. The aim of this study is to evaluate the influence of HAART on the prevalence and spectra of dermatologic disorders in HIVinfected patients Method: We collected data from 113 HIV-infected patients on whom HAART was initiated in our HIV clinic between 1 June 2005 – 31 May 2006 and thus have received HAART for at least 6 months. The primary outcomes were dermatologicmanifestations after HAART. All diagnoses were based on patient history, physical examination, dermatologic consultation and laboratory investigations. Results: Dermatologic manifestations occurred in 40 patients (35.4%) after HAART. Mean HAART duration was 55 + 61 days (range 7– 241 days). Eosinophilic folliculitis and drug eruptions were the most common findings (N = 10, 8.8%). The next most common conditions were mycobacterial infections (N = 4, 3.5%), non-specific dermatitis (N = 4, 3.5%), herpes zoster infection (N = 3, 2.7%), idiopathic pruritus (N = 3, 2.7%), lipodystrophy (N = 2, 1.8%), herpes simplex infection (N = 2, 1.8%), histoplasmosis (N = 1, 0.9%) and psoriasis (N = 1, 0.9%). Independent risk factors for skin manifestations after HAART by univariate analysis were female (60% vs 30%, p = 0.003), lower nadir CD4 counts (64.3 vs 107.8, p = 0.024) and higher percentage of eosinophils at the time of dermatologic diagnosis (9.1% vs 5.2%, p = 0.004). Different HAART regimens did not seem to affect the incidence. Female sex and peripheral eosinophilia were confined to the groups of eosinophilic folliculitis and drug eruptions. There was no significant difference in the number of CD4 increase between patients with or without skin manifestations. We observed five cases of skin disorders due to opportunistic infections: four of mycobacterium infections (infiltrative erythematous plaque 1, subcutaneous abscess 1, painful erythematous nodules 1, and visible lymph node protrusion 1 and one of histoplasma lymphadenitis.
Age (years) Gender (M:F) HAART regimens (N) 1. NVP-based 2. EFV-based 3. PI-based Nadir CD4 count (cell/ml) Number of CD4 increase (cell/ml) WBC (cell/mm3 ) Percentage of eosinophils (%) AST (IU/dl) ALT (IU/dl)
Skin manifestation group Yes (N = 40) No (N = 73)
P-value
36.98±9.475 16:24
39.18±9.3 51:22
0.23 0.003*
14 14 12 64.35&±72.84 73.8±68.25 5951±2552 9.13±7.52 92.7±235.9 65.85±134.17
20 35 18 107.84±129.45 88.7±125.64 6312±3085 5.25±3.71 39.38±21.63 32.44±23.95
0.92 0.29 0.53 0.024* 0.419 0.511 0.04* 0.16 0.13
Conclusion: In the HAART era, eosinophilic folliculitis and drug eruptions are the most prevalent dermatological manifestations in our referral hospital. These are closely related to peripheral eosinophilia in this population. Physicians initiating HAART on a female especially with a low CD4 count should be aware of this consequence.
17th ECCMID / 25th ICC, Posters
Conclusion: The proportion of liver-related deaths and particularly hepatocellular carcinoma increased between 2000 and 2005 in HIVinfected adults, while the proportion of AIDS related death has decreased. This justifies a more aggressive treatment of viral hepatitis C and B, the prevention of alcohol consumption, and an early and regular screening for hepatocellular carcinoma in case of cirrhosis.
No. of deaths with known status for HBV and HCV Death from liver disease among which Hepatocellular carcinoma Main cause of liver disease HCV HBV HCV + HBV Alcohol Other Median age Median CD4 cell count/mm3
2000
2005
822
831
110 (13%) 17 (15%)
125 (15%) 31 (25%)
72 (65%) 14 (13%) 16 8 – 41 90
90 (72%) 16 (13%) 6 8 5 46 165
P644 Longitudinal evaluation of the prevalence of insulin resistance in a cohort of HIV vertically-infected children and adolescents R. Rosso, A. Parodi, E. Repetto, C. Torrisi, C. Bernardini, F. Ginocchio, M.P. Sormani, M. Vignolo, C. Viscoli (Genoa, IT) Background: To assess the rate of progression insulin resistance (IR) and the associated metabolic disturbances over a 1-year period in HIV vertically-infected children and adolescent and to assess risk factors associated. Methods: 48 children (age range 6−22 years; 21 F, 27 males) were followed over a mean period of 14 months (range 5−27). Fasting lipids and glucose profile were measured in all children. Therapy and disease history, presence of lipodystrophy, possible co-infections, axiological features were recorded at the baseline and at the end of the follow-up. Results: At baseline, fasting insulin and HOMA-IR were significantly higher in HIV-infected patients than in healthy children and adolescents (p < 0.001). Therapy duration (r = 0.281, p < 0.05), triglycerides (r = 0.286, p < 0.05), age (r = 0.299, p < 0.05), BMI (r = 0.485, p < 0.001) were significant predictor variables of IR, expressed as HOMA-IR >3. At baseline and at the end of follow-up, 36% vs. 29% of pts showed IR; and 32% vs. 33% showed dyslipidaemia (high cholesterol, or triglycerides or both), respectively. The proportion of patients presenting lipodystrophy remained stable (16.6%). Prospective follow-up showed no progression at all over 1 years, in particular the number of patients with IR remained the same but the level of mean HOMA-IR increased slightly (2.6±1.6 vs 3.8±8.1), showing no correlation with therapy duration as a whole and particularly with PI-based HAART. HAART, defined as association of 3 antiretroviral drugs, seems not to be related with a worsening in IR. Sex, birth weight, HCV-infection have no relation with IR, while lipodistrophy, Tanner stage IV-V of puberty, hyper triglyceridaemia seem to be predictor variables of IR both at baseline and at the end of followup (p < 0.05). Conclusions: In HIV-infected children IR and other metabolic complications, such lipodystrophy are more likely to develop after midpuberty. Progression of disorders of glucose metabolism seems to be slow but, regarding their enlarged life expectancy, efforts to prevent the development of such complications should be targeted toward HIVinfected children with an at least annual (using fasting glycaemia and insulin) follow-up.
P645 Diverse dermatologic manifestations in HIV-infected patients after highly active antiretroviral therapy K. Jutivorakool, P. Plussind, H. Choengwiwatkit, J. Waiwarawut (Chonburi, TH) Objective: Highly active antiretroviral therapy (HAART) has increased survival in HIV patients. However, there are few studies on skin manifestations in HIV-infected patients after HAART with somewhat conflicting data. The aim of this study is to evaluate the influence of HAART on the prevalence and spectra of dermatologic disorders in HIVinfected patients Method: We collected data from 113 HIV-infected patients on whom HAART was initiated in our HIV clinic between 1 June 2005 – 31 May 2006 and thus have received HAART for at least 6 months. The primary outcomes were dermatologicmanifestations after HAART. All diagnoses were based on patient history, physical examination, dermatologic consultation and laboratory investigations. Results: Dermatologic manifestations occurred in 40 patients (35.4%) after HAART. Mean HAART duration was 55 + 61 days (range 7– 241 days). Eosinophilic folliculitis and drug eruptions were the most common findings (N = 10, 8.8%). The next most common conditions were mycobacterial infections (N = 4, 3.5%), non-specific dermatitis (N = 4, 3.5%), herpes zoster infection (N = 3, 2.7%), idiopathic pruritus (N = 3, 2.7%), lipodystrophy (N = 2, 1.8%), herpes simplex infection (N = 2, 1.8%), histoplasmosis (N = 1, 0.9%) and psoriasis (N = 1, 0.9%). Independent risk factors for skin manifestations after HAART by univariate analysis were female (60% vs 30%, p = 0.003), lower nadir CD4 counts (64.3 vs 107.8, p = 0.024) and higher percentage of eosinophils at the time of dermatologic diagnosis (9.1% vs 5.2%, p = 0.004). Different HAART regimens did not seem to affect the incidence. Female sex and peripheral eosinophilia were confined to the groups of eosinophilic folliculitis and drug eruptions. There was no significant difference in the number of CD4 increase between patients with or without skin manifestations. We observed five cases of skin disorders due to opportunistic infections: four of mycobacterium infections (infiltrative erythematous plaque 1, subcutaneous abscess 1, painful erythematous nodules 1, and visible lymph node protrusion 1 and one of histoplasma lymphadenitis.
Age (years) Gender (M:F) HAART regimens (N) 1. NVP-based 2. EFV-based 3. PI-based Nadir CD4 count (cell/ml) Number of CD4 increase (cell/ml) WBC (cell/mm3 ) Percentage of eosinophils (%) AST (IU/dl) ALT (IU/dl)
Skin manifestation group Yes (N = 40) No (N = 73)
P-value
36.98±9.475 16:24
39.18±9.3 51:22
0.23 0.003*
14 14 12 64.35&±72.84 73.8±68.25 5951±2552 9.13±7.52 92.7±235.9 65.85±134.17
20 35 18 107.84±129.45 88.7±125.64 6312±3085 5.25±3.71 39.38±21.63 32.44±23.95
0.92 0.29 0.53 0.024* 0.419 0.511 0.04* 0.16 0.13
Conclusion: In the HAART era, eosinophilic folliculitis and drug eruptions are the most prevalent dermatological manifestations in our referral hospital. These are closely related to peripheral eosinophilia in this population. Physicians initiating HAART on a female especially with a low CD4 count should be aware of this consequence.