Final Program and Oral Abstracts [International Conference on AIDS (8th: 1992: Amsterdam, Netherlands)]

MoC 0028-MoC 0033

MONDAY, 20 JULY 1992

MoC 0028 SEXUALLY TRANSMITTED DISEASES AND HIV AMONG YOUNG THAI MEN. Eiumtrakul.
Sako*; Matanasarawoot, A.*; Tulvatana, S.**; Celentano, D. ***; Nelson, K***; Wright,
N.****. *Chiang Mai University, **Royal Thai Army and Air Force; ***Johns Hopkins
University, Baltimore, MD, USA; **** RWJ Medical School, New Jersey, USA.
Objective: Sexually transmitted diseases (STDs) have been identified as risk factors for heterosexually
transmitted HIV infection in numerous epidemiologic studies. While studies of heterosexual transmission in
the USA have suggested a low efficiency of HIV transmission, the rate of heterosexual transmission appears
to be much higher in Thailand and may be due in part to higher prevalence of STDs, including genital ulcer
disease and syphilis. We report here on the association between history and symptoms of STDs and
prevalent HIV infection in a cross-sectional sample of young men in northern Thailand.
Method: Using baseline interview and serological results of the Thai Male Health Study, a prospective
investigation of risk factors for prevalent and incident HIV infection, the association between self reported
history of STDs and HIV serologic status were compared in a sample of men (mean age = 21 years) in May
1991 (135 seropositives, 1101 seronegatives, 10.9% seroprevalence).
Results: Rates of reported STDs and symptoms demonstrated significant differences by HIV status:
Reported STDs % HIV + % HIV - OR 95%CI MultOR 95%CI
Gonorrhea 55.5% 26.0% 3.6 2.5,5.1 2.2 1.5,3.3
Syphilis 16.3% 5.8% 3.2 2.0,5.3 1.4 0.8,2.6
Nongonnococcal Urethritis 19.3% 7.4% 3.0 1.8,4.8 1.2 0.7,2.1
Herpes, Chancroid 49.6% 15.4% 5.4 3.7,7.9 3.8 2.4,5.5
Genital Warts 23.0 5.1% 5.9 3.6,9.6 3.2 1.9,5.6
Conclusion: The frequent occurrence of HIV with STDs in this young population is of great concern. STDs
may increase the infectiousness of index partners through increased shedding of HIV, and the susceptibility
of the contact may also be increased. The high prevalence of both STDs and HIV may create conditions in
northern Thailand where heterosexual transmission of HIV is common.
Lt. Col Sakol Eiumtrakul, MD Medical Director, Kavila Army Hospital
Royal Thai Army, Kavila Camp, Muang District, Chiang Mai Thailand
Fax: [phone]
MoC 0030 GENDER DIFFERENCES IN THE NATURAL HISTORY OF HIV INFECTION
Szabo S, Miller LH, Sacks Henry S*, Gurtman AC, Rose DN, Kee RA,
Cheung TW and Cohen SE. The Mount Sinai School of Medicine, New
York, NY, USA.
OBJECTIVE: To compare the natural history of HIV infection in men and women.
METHODS: Retrospective chart review of 149 HIV infected women (HW) and 111 HIV
infected men (HM) registered in the Infectious Disease clinic from 8/87 to 7/91
at an inner city tertiary care center.
RESULTS: 149 HW age 33 + 7.6 yrs (mean + SD) and 111 HM, age 36 + 8.5 yrs were
followed for 11.2 + 11.0 and 12.3 + 11.1 mos,respectively. 52% of HW and 57% of
HM were hispanic, 39% of HW and 30% of HM were black and 9% of HW and 13% of HM
were white. 48% of HW acquired HIV heterosexually and 37% via IVDU; 29% of HM
were homosexual, 10% were heterosexual and 48% were IVDU. At initial presentation
to clinic, 54% of HW and 37% of HM were asymptomatic (asx), 30% of HW and 43% of
HM had ARC and 16% of HW and 20% of HM had AIDS (p <.05); HW had CD4 count of
336 + 294; HM had CD4 count of 247 + 269 (p <.05). The frequencies of AIDS
defining OI's in HW and HM were: PCP (46% and 33%), candida esophagitis (17% and
8%), disseminated (D) MAI (0 and 17%), toxoplasmosis (13% and 0%), extrapulmonary
tuberculosis (13% and 8%), CMV retinitis (4% and 0%), wasting syndrome (4% and
8%), cryptococcal meningitis (4% and 4%), KS (0% and 8%), D histoplasmosis,
dementia and D herpes (0% and 4%) (all p >.05). Overall progression to AIDS was
8% for HW and 17% for HM, progression to AIDS for asx HW was 2.5% and for asx HM
was 7.3%; for HW with ARC 18% and HM with ARC 25%. Overall survival for HW was
84.6% and for HM 89.2%; for asx HW 95% and asx HM 100%, for HW with ARC 77.8% and
HM with ARC 91.7%, and HW with AIDS 62.5% and HM with AIDS 64% (all p >.05).
CONCLUSIONS: At our center, HW entered care at earlier stages of disease, with
higher CD4 counts, than HM. Patterns of OIs, survival and disease progression
were similar in HW and HM. Thus, as the epidemic evolves, early concerns that
HIV infection is more severe or different in women are not being substantiated.
Prospective studies are needed.
Henry Sacks, Mount Sinai School of Medicine, Box 1042,
1 Gustave Levy Place, New York, NY 10029
[phone] FAX [phone]
MoC 0032 GENDER DIFFERENCES IN THE SPECTRUM OF HIV DISEASE
Creagh. Teri*, Thompson, M.*, Morris, A.*, ARCA Spectrum of Disease Working Group*1,
Whyte, B.**, *AIDS Research Consortium of Atlanta, Inc. Atlanta, Georgia, lEmory University
School of Medicine, Atlanta, Georgia, **Department of Human Resources, Georgia, USA.
Objective: To determine gender differences in the spectrum of HIV disease in adults.
Methods: All HIV-infected adults (>13 yrs) entering the office or clinic of a participating site between February 1, 1990
and December 1, 1990 were eligible for enrollment. Thirty-two private practitioners (Internal Medicine, Family Practice
and Infectious Disease) have participated. Medical records are abstracted onto a standard data collection form by trained
personnel. Data are collected for a 12 month interval prior to enrollment and 6 month intervals after enrollment. Patients
are followed until death or loss-to followup. Data collected include demographic information, transmission mode, CDCdefined AIDS diseases/conditions, other infections and conditions, treatments, and laboratory results. The study and
analyses are ongoing.
Results: A total of 2,606 men and 252 women were enrolled. Median follow-up time was similar for women and men
(24 months for both). Mean age of women was 32.9 years compared to 35.3 years for men (p=.002). Mean CD4
lymphocyte count at baseline was 356 for women and 274 for men (p=.0001). After enrollment, women who were
diagnosed with AIDS during follow-up were diagnosed significantly later (8.2 months versus 6.9 months) than men, as
would be predicted from baseline CD4 counts. Analyses of risk for development of specific opportunistic infections
showed no gender differences, when stratified by baseline CD4 counts. Overall estimates of survival according to gender
showed no significant differences. However, when the cohort was stratified according to baseline CD4 counts, women with
less than 100 CD4 cells survived a significantly shorter time than men (median survival 25 months versus 29 months,
p<.01).
Discussion: Some studies have indicated that the course of HIV disease in women may lead to earlier mortality than is
seen in men. In assessing survival by gender, it will be important to determine whether stage of disease is comparable. In
our cohort, a survival analysis which controlled for baseline CD4 counts showed that women in later stages of HIV
infection have more rapid disease progression than men.
Conclusion: Women with HIV infection may have a poorer prognosis than men at comparable baseline CD4 counts.
Creagh, Terri. AIDS Research Consortium of Atlanta, Inc., 131 Ponce de Leon Avenue, Suite
220, Atlanta, Georgia 30308, USA, (404)-876-2317, FAX [phone]

MOC 0029 WHAT PROPORTION OF HIV INFECTIONS ARE ATTRIBUTABLE TO GENITAL
MoC 0029f ULCERS IN SUB-SAHARAN AFRICA?
Haves, Richard J.; Schulz, Kenneth F.
London School of Hygiene and Tropical Medicine, London, UK.
Objectives: The heterosexual transmission of HIV is assumed to be facilitated in
the presence of other STDs, but the strength of this effect, and the proportion of
HIV infections in sub-Saharan Africa attributable to the presence of STDs, are
unknown. This study considers problems in the estimation of this cofactor effect,
and uses data from previously reported studies to produce rough estimates of (i) the
per-exposure effect of genital ulceration (GUD), and (ii) the fraction (PAF) of HIV
infections in African populations which may be attributable to GUD.
Methods: Data from a longitudinal study of prostitutes in Nairobi were used to
estimate the cofactor effect of GUD on male-to-female transmission per HIV exposure,
by allowing for the number of exposures. The cofactor effect on female-to-male
transmission was estimated from a longitudinal study in Nairobi of males following
a single prostitute contact. Likely values of the PAF were estimated for a
population with a current adult HIV prevalence of about 10% using a range of
plausible assumptions about the frequency of GUD and of HIV-exposure.
Results: The data are compatible with a relative risk of transmission per HIVexposure of about 20-40 for male-to-female transmission, and of about 100-2000 for
female-to-male transmission, in the presence of GUD. Rough estimates of the PAF
were around 20% for prostitutes, and 75-98% for males and 20-40% for females in the
general population.
Conclusions: These estimates rest on a number of assumptions, and should be
interpreted cautiously. The wide range in the estimates reflects uncertainties in
(i) the size of the cofactor effect, especially for female-to-male transmission, and
(ii) the frequency and pattern of occurrence of GUD and HIV-exposure in the general
population. However, they suggest that STD control might have a substantial effect
on the spread of the epidemic.
Hayes, Richard J, London School of Hygiene and Tropical Medicine,
Keppel Street, London WC1E 7HT, England. Tel: [phone],
Fax: [phone].
MoC 0031 GENDER, HIV-RELATED CLINICAL EVENTS,
MoC 00 1 AND MORTALITY: PRELIMINARY OBSERVATIONAL DATA FROM THE COMMUNITY
PROGRAMS FOR CLINICAL RESEARCH ON AIDS (CPCRA). Melnick, S; Sherer. Renslow;
Hillman, D; Rodriguez, E; Lackman, C; Capps, L; Korvick, J; Vermund, S; Carlyn, M; Deyton,
L. Division of AIDS, NIAID/NIH, Bethesda, MD, USA.
Objectives: Possible gender differences in HIV-associated clinical events and mortality may have care implications.
Gender differences were assessed using observational data collected on 843 women (20%) and 3,359 men (80%) from
17 CPCRA centers.
Methods: Demographic and clinical data were collected at least every 6 months. The relative risk (RR) of event/death
incurred by women compared to men was computed by the Cox model, with stratification by CPCRA center, CD4,
AIDS, age, weight, Karnofsky, and race. Incident events were defined as those occurring for the first time during the
follow-up interval, excluding participants with any HIV-related event at enrollment.
Results: 40% of the 4,202 participants were African-American, 18% Latino/Hispanic, 42% White. 70% were aged
30-49. 19% of women and 28% of men were drug-users. 42% had CD4 < 200; 70% had CD4 < 500. RR's were
computed for several clinical events, including PCP, oral and esophageal candidiasis (OCa, ECa), herpes zoster (HZV),
M. avium (MAI), and cytomegalovirus (CMV). The average length of follow-up was 6.6 months.
Incident Event Number of Event or Death Adjusted RR 95% CI P Value
Events/Death per 100 person-years (women/men)
PCP 52 7.9 1.25 0.48, 3.25 0.64
OCa 131 20.2 1.03 0.58, 1.83 0.91
ECa 54 8.2 1.13 0.43, 2.94 0.80
HZV 41 6.2 0.94 0.31, 2.83 0.91
MAI 41 6.2 1.10 0.36, 3.31 0.87
CMV 40 6.1 1.09 0.36, 3.28 0.88
> 1 Event 177 27.7 0.79 0.49, 1.29 0.35
Conclusions: These preliminary findings suggest no significant gender differences in clinical events/death after
adjustment for important confounders.
MoC 0033 AGE ACCELERATES THE
MoC 0 3 PROGRESSION FROM HIV-SEROCONVERSION TO AIDS IN WOMEN
Italian Seroconversion Study (HIV-ISS)* -AIDS Unit, Istituto Superiore di Sanits, Roma (Italy)
Obiectives: To estimate the risk of developing AIDS for women compared to that of men, and to
identify predictors of clinical progression in women.
Methods: We conducted a longitudinal study, enrolling individuals for whom the seroconversion
period could be estimated (i.e. availability of a negative serological test and a subsequent HIVpositive test within two years of the former date). The seroconversion date was estimated as the
midpoint between the last negative and the first HIV-positive test. The end-point of the analysis
was the AIDS diagnosis. Disease progression was analyzed according to estimates based on KaplanMeier survival curves. Differences among groups were assessed by the log-rank test.
Results: Two-hundred-thirty-four females (141 IDUS; 93 heterosexual contact) and 422 males (377
IDUS; 45 heterosexual contact) from 16 Italian clinical facilities were enrolled in the study. The
mean age was 25.93 years (24.59 for females and 26.67 for males). The median seroconversion
interval (the period between the last negative and first positive test) was 7.95 months (8.02 for
females and 7.06 for males). The median follow-up time was 43.97 months (38.23 females; 45.23
males). Seven women and 31 men developed AIDS during the study period. The estimated
cumulative incidence of AIDS was 3.49% (95% C.I. 0.24-6.74) for women and 6.08% (95% C.I.
3.30-8.86) for men within 4 years after seroconversion. No significant differences were found in
the progression of HIV between women and men. Women over 25 years old at seroconversion were
more likely to develop AIDS than those younger than 25. No differences were found in women
between injecting drug users and heterosexual contacts.
Conclusions: In industrialized countries, the natural history of HIV infection in women does not
seem to differ from that of men. Factors such as older age at seroconversion may play a role in
accelerating the progression from HIV infection to AIDS.
* Rezza G, Pezzotti P, Dorrucci M, Angarano 0, Castelli F, Sinicco A, Costigliola P, Canessa A, Pristera R, Zerboni R, Zaccarelli M,
Viale P, Gafa S, Salasa B, Aiuti F, Laosarin A, Ortona L, Tirelli U, Barbanera M.
DORRUCCI MARIA
AIDS-UNIT, ISTITUTO SUPERIORE DI SANITA'
V.LE REGINA ELENA,299 TEL.[phone] FAX [phone]

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