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

TRACK C: EPIDEMIOLOGY

MoC 0060-MoC 0065

MoC 0060 MEDIA AND MAGIC: THE EFFECTS OF MAGIC JOHNSON'S HIV DIAGNOSIS ON MOC 0061 THAILAND'S FIRST ANONYMOUS ALTERNATIVE TEST SITE: A LESSON FOR
HIV ANTIBODY TESTING RATES Mills, Stephen; Fischer-Ponce, L San ASIAN COUNTRIES. Phanuohak. Praohan; Sittitrai, W.;Barry.
J.;Sarang-Bin. S.; Hanvanich. M. Program on AIDS. Thai Red Cross
Francisco Dept of Public Health, AIDS Office; SF CA; USA Society. Bangkok. Thailand.

OBJECTIVE: To determine the effects of sports celebrity Magic Johnson's HIV
diagnosis on HIV antibody testing rates in San Francisco.
METHODOLOGY: We calculated the expected HIV testing rates following the announcement
and media coverage of Magic Johnson's HIV diagnosis based on the observed three
month trends prior to the announcement. These expected rates were then compared to
the observed rates following the announcement and concluding at year end 1991.
RESULTS: HIV testing rates increased by approximately 20% following Magic Johnson's
HIV diagnosis - an effect which lasted about seven weeks and is potentially
responsible for an estimated 620 additional individuals receiving HIV counseling and
antibody testing in San Francisco. This effect may have been longer, but appeared to
be dampened by the holiday season, a typically low HIV testing period. Rate changes
were highest among Latina women (56% increase), African American women (52%),
Caucasian women (39%), Asian men (27%), and African American men (23%). Usage by
Caucasian males, the largest HIV testing client group, did not significantly
increase. First-time HIV testers increased by 32%, whereas usage by individuals
previously tested did not significantly increase. The HIV seroprevalence of testing
clients decreased from 5.7% to 4.0% (p<.001).
CONCLUSIONS: This study provides compelling evidence that Magic Johnson's HIV
diagnosis had the profound behavioral effect of motivating individuals to be HIV
tested. This effect was most pronounced among women - specifically women of color -,
suggesting that his diagnosis may have affected female sexual partners of
heterosexual men most strongly. While the decline in HIV seroprevalence suggests
that a lower-risk population sought testing, the future preventive effects of this
intervention are significant. Finally, this study demonstrates the substantial, yet
under-utilized, influence the media and celebrities can exert in HIV prevention.
Stephen Mills, AIDS Office, 25 Van Ness Ave., Suite 500, San
Francisco, CA, 94102, USA. Telephone: [phone].
FAX: [phone].
MoC 0062 TWELVE YEAR FOLLOW-UP OF A HAEMOPHILIC COHORT.
Lee, Christine; Sabin, C; Phillips, A; Elford, J; Griffiths, P; Janossy, G.
Haemophilia centre, Royal Free Hospital, London, England.
Objective: To describe the progression of HIV disease in a haemophilic cohort.
Methods: A longitudinal clinical and laboratory study was conducted in 111 patients from time of
first seroconversion in October 1979 until 1st January 1992.
Results: 38/111 (34%) have developed AIDS. 39/111 (35%) have died (4 of liver failure
including hepatoma).
Using Kaplan-Meier plots, the calculated progression to AIDS at 12 years is 45% (95% CI
31-58): if age >25 yrs 63% (95% CI 45-82), age < 25 yrs 32% (95% CI 15-48, p=0.0001);
CMV+ve 68% (95% CI 48-87), CMV-ve 20%
(95% CI 8-32, p=0.0009). Twelve year ". " ...... -
progression rate to CD4+ 0.2 is 64% o.. r:
(95% CI 53-76), to CD4+ 0.05 is (53%.
(95% CI 34-73). a
21/34 (62%) patients who are p24 antigen
+ve have developed AIDS compared to
17/77 (22%) who are p24 antigen -ve
(p=0.0001). 19/34 (56%) and 20/77 (23%),,,,,, *.....
of those p24+ve and -ve respectively v`r.ero.m.. er
have died (p=0.007).
Before antiviral and prophylactic treatment for non-AIDS (Nov 88) there were 9 AIDS
cases in 3.84 years experience with CD4+ < 0.05 (1/0.43 yrs) and since treatment 10 AIDS
cases in 18.22 years (1/1.8 yrs).
Conclusion: Age, CMV status and p24 remain strongly predictive of progression. Treatment appears
to have reduced the incidence of AIDS.
Lee, Christine, Haemophilia Centre, Royal Free Hospital, Pond Street, London.
NW3 20G.
Telephone: [phone] Fax: [phone]
MoC 0064 RACIAL DIFFERENCES IN RATE OF CD4 DECLINE IN
HIV-1 INFECTED HOMOSEXUAL MEN Easterbrook. Philippa J. *;Margolick, J. *; Saah,
AJ.*; Farzadegan, H. *; Kaslow, R.**; Vlahov, D.*; Chmiel, J.;*** *Johns Hopkins Schoo of
Public Health, Baltimore, MD.; **NIAID, Bethesda, MD.; ***University of Chicago, IL
Objective: To determine if racial differences exist in the rate of CD4 cell decline, progression to AIDS and survival in HIV1 infected homosexual men.
Methods: Prospective cohort study of 321 non-Hispanic white (W) and 102 black (B) HIV-1 seropositive homosexual men
recruited from the Baltimore/Washington D.C. metropolitan areas between 1984-1985 and 1987-1990, and evaluated semiannually. Change in CD4 count over time was analyzed using linear regression procedures for the 271 W and 69 B participants
who had at least 4 semi-annual CD4 counts.
Results: Decline in CD4 cell count over time was much slower among B compared to W seroprevalent men for all
categories of baseline CD4 count.
WHITE BLACK
Baseline CD4 cells/al N Median decline/ 6 months N Median decline/ 6 months
201-400 52 17.7 14 0.2 *
401-600 76 23.9 19 11.3 *p >0.01, f0.05
601-800 62 35.2 18 15.1 ** p ~0.01
2 801 81 42.7 18 4.3 * *
These racial differences persisted after adjustment for age at baseline, recruitment period (1984-1985, 1987-1990), duration of
follow-up, and receipt of zidovudine therapy orPCP prophylaxis. Similar findings were also observed among the 32 W and 11
B seroconverters but not with the W and B seronegative controls. No significant racial differences were found in the rate of
progression to AIDS or in overall survival, but the number of these events among non-whites was small (15 AIDS cases and
11 deaths).
Conclusions: This preliminary analysis suggests a more gradual CD4 cell decline among black Americans. The clinical
significance of and reasons for this are unclear, but racial differences in the immune response to HIV may exist. Additional
longitudinal studies are in progress to validate these findings in a larger cohort of non-whites, and to assess their relationship
with other measures of cell-mediated immune function and levels of p24 antigenemia.
Philippa J. Easterbrook. Westminster and St. Stephens Hospital, 369 Fulham Road, London SW10
9TH, U.K. Telephone: [phone]; FAX: [phone]

Issue: People at risk for HIV infection often hesitate to take an anti-HIV test for
fear of social stigmatization should test results turn out to he positive. Thus, many
HIV infected persons remain undetected and spread the infection unknowingly. In
some cases, people resort to the less threatening ttrategy of donating blood aware
that, should they be HIV positive, they will be notified by the receiving agency. In
order to cope with this situation the Thai Red Cross Society (TRCS) estab ished an
Anonymous Testing Center in July 1991.
Thge roieed: Paci ities for HIV testing and counseling were set up on the grounds of
the TRCS under the name "Anonymous Cl inic" (AC) in the center of Bangkok, next to
Chulalongkorn University. The staff includes medical doctors, psychologists,
technicians, and volunteer counselors. Potential counselors were recruited mainly
from the TRCS personnel and were given extensive training for HIV counseling.
Exemption of case reporting according to the Infectious Disease Act was granted by
the uMinistrg of Public Heafth. The cooperation of the mass media was enlisted to
publicize te activities of the AC. To minimize stigmatization, the AC offers other
health services such as testing for hepatitis B and syphilis. Clients attending the AC
are asked to answer anonymously a questionnaire for demographic data and for
attitudes and behaviors related to AIS. Such data are used for research on trends
of risk behaviors and for improving services.
ReultiL: During the first six months of operation 5.347 clients attended the AC. HIV
infection prevalence was 10%. The majority of the seropositive clients were
promiscuous heterosexual males followed by married women aware of the extramarital activities of their husbands. The need for such anonymous testins services
has expanded to almost every province in Thailand. The Ministry of Public Health
had to repeal the law requiring official reporting of HIV infections. The TRCS is now
providing monthly workshops to train personnel ofrom provincial hospitals on how to
set up and operate anonymous HIV testing and counseling clinics.
Lessons learned: Anonymous HIV counseling and testing has been received with an
overwhelming response in Thailand. This seems to be an approach quite appropriate
for countries where the incidence of HIa inlection is rising rapidly. Success in
operating such a program requires concerted planning and efforts. The experience of
Thailand could well serve other countries with problems and cultures similar to Thailand.
Praphan Phanuphak, Program on AIDS, Thai Red Cross Society,
1871 Rama IV ooad, Bangkok 10330, Thailand.Telephone: [phone]. PAX: 662-254-0212.

MoC 0063

ACUTE PRIMARY HIV-1 INFECTION (API):
RISK OF DEVELOPING AIDS
Alessandro Sinicco, M. Sciandra, A. Lucchini, R. Fora,
P. Caramello, P. Gioannini.
Inst. of Infect. Dis., Univ. of Turin, Turin, Italy.

Objective: to evaluate the risk of developing AIDS after API.
Patients and methods:from 9/85 to 9/91 we enrolled 134 newly infected
subjects (NI) in a prospective study. Only NI who had a previous
negative HIV test in the 12 months preceeding seroconversion were
admitted to the study. The 134 NI were divided in two groups; group A:
23 NI were directly observed during an API; group B: 111 NI were
asymptomatic seroconverters. In group B the time of seroconversion was
estimated as the mid-point between last and first positive HIV-1
antibody result. Life tables were used to calculate the annual
incidence rate of AIDS and Kaplan Meier analysis product limit method
to determine survival curves. Results: sexual transmission of HIV-1
infection was significantly higher in group A than in group B
(X*=16.86; p=.00001). IVDUs were rarely affected by API and presented
with a milder symptomatology. NI observed with API had a significantly
higher risk of developing AIDS than group B (68% at 56 m versus 20% at
66 m; p=.026). Low CD4+ counts at the onset of API and delayed
seroconversion in ELISA were associated with evolution to AIDS (p=.04
and p-.01). During the follow-up, group A patients were more likely to
show an early fall of CD4+ cell count below 200/1i than group B
patients (p=.026). Conclusion: The route of transmission may play a
role in determining the appearance of API. The risk of developing AIDS
after API is significantly higher. This observation suggests an early
antiviral treatment as a possible measure to control the disease
progression.
ALESSANbRO -S.NICCO, 15T. M0.LATn I-NFETTJQE, )NIV. bi TOkNO
COaRSO s 9:.jlRA._Arv, ".oA9T, ro-1- IO -ALIA
TELePy0aO;- (CO-4) S,4zRi - FAe (cB4 554aA
MOC 0065 PROGRESSION OF HIV INFECTION AMONG HOMOSEXUAL MEN IN HBV VACCINE
COHORTS IN AMSTERDAM (AM), NEW YORK CITY (NY) AND SAN FRANCISCO
(SF), 1978-1991.
Van Griensven.Godfried JP*;Hessol,NA+; Kobl in, BA; Stevens, CE;Kat z,
MH+;Coutinho,RA*.Municipal Health Service,AM;+AIDS Office,SF;#New
York Blood Center,NY.
Obiective:To study progression of HIV infection from date of HIV seroconversion to
AIDS and death in order to evaluate the impact of socio-demographic variables and the
use of zidovudine (AZT) and Pneumocystis carinii pneumonia (PCP) prophylaxis (PCPP).
Methods: Participants were homosexual men with well documented dates of HIV
seroconversion who participated in hepatitis B vaccine trials in AM (n=84), NY (n=121)
and SF (n=168). Progression of HIV infection was evaluated using Kaplan-Meier and Cox
proportional hazard analysis. Variables included in the analysis were age, race, study
site, AZT and PCPP use and presenting AIDS diagnosis.
Results: Of the 373 men, 35 were diagnosed with AIDS in AM, 51 in NY and 75 in SF.
By the end of 1991, 18 of these men had died in AM, 33 in NY and 52 in SF. The median
time from seroconversion to AIDS was 10.5 years; from AIDS to death 1.9 years and from
seroconversion to death 12.2 years. Significantly fewer men presented with KS in AM
than in NY or SF. AIDS cases in AM were more likely to occur after 1986 and were less
likely to have used AZT or PCPP. Among the three cohorts combined, younger age and
receiving treatment with AZT and PCPP were significantly related to a longer survival
from seroconversion to AIDS and from seroconversion to death. No differences were
found in survival by city. However, after adjusting for year of AIDS diagnosis, AIDS
presenting diagnosis, use of AZT and PCPP, AIDS cases in NY and SF had a significantly
shorter survival from AIDS diagnosis to death than those in AM.
Conclusionst There were distinct geographical differences in the proportion of men
with KS as presenting AIDS diagnosis. The smaller proportion of men in AM having used
AZT and PCPP suggests a reservation towards therapy in AM compared to the American
cities. Differences in survival time from seroconversion to AIDS and from
seroconversion to death suggest a longer survival among those younger and among those
receiving treatment with AZT and PCPP. Since this study is not a clinical trial this
finding needs to be interpreted with caution.
Godfried JP van Griensven, Municipal Health Service, Department of
Public Health and Environment, Nieuwe Achtergracht 100, 1018 WT
Amsterdam, The Netherlands. Telephone: [phone], FAX: [phone].
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