Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Track B: Clinical Science

Mo.B.1205 - Mo.B.1210

Conclusions: although as with SMX, SMT is probably activated to a hydroxylamine in vitro,
SMT is significantly less toxic compared with SMX.This may be due to reduced activation of
SMT to the hydroxylamine and instability of the toxic species. Future clinical trials will determine if this difference shown in vitro occurs in vivo.
M.D. Coleman, Pharmaceutical Sciences Institute, Aston University Birmingham, B4 7ET UK.
Telephone 44 I 2 1359 36 I I; FAX 44 I 2 1 359 0733; email [email protected]
Mo.B. 1205
A NATIONAL STUDY OF ACCESS TO DENTAL CARE FOR HIV-INFECTED PATIENTS
IN CANADA
McCarthy Gillian M, MacDonald JK. University of Western Ontario, London, Ontario, Canada
Objective: To investigate dentists refusal to treat patients with HIV in Canada.
Methods: A confidential mailed survey including items on sociodemographics, knowledge,
attitudes and infection control was distributed to a random sample of all licensed dentists in
Canada (n=6444). Follow-up included a reminder postcard and two additional mailings of
the questionnaire to non-respondents. Using SPSS.PC+, all significant variables from chi
square analyses were entered into a multiple logistic regression using a backwards stepwise
method to determine the best predictors of refusal to treat HIV patients.
Results: The response rate was 66.4%. Of the respondents, 82.2% reported that they were
willing to treat, 15.2% reported that they would refuse to treat patients with HIV, and
30.2% reported that they had knowingly treated HIV patients in the last year.The best predictors of refusal to treat were respondents' reports that they do not have an ethical
responsibility to treat patients with HIV (OR= 11.0); were unwilling to attend a dentist who
treats HIV patients (OR=4.3); disagreed that HBV is more infectious than HIV (OR=2. I);
believed that it would be difficult to deal with staff fears about HIV/AIDS (OR=2. I), that
they could not safely treat HIV patients in their offices (OR=2.0), or that other patients
would be reluctant to continue receiving care if they treat HIV patients (OR= 1I.8).
Conclusions: Approximately 15% of dentists in Canada report that they would refuse to
treat patients with HIV and this was primarily associated with a lack of ethical responsibility
Other predictors include fears related to cross infection, knowledge of infectivity of HIV and
loss of other patients if a dentist provides treatment for persons with HIV/AIDS.
Dr. G. M. McCarthy Faculty of DentistryThe University of Western Ontario, London,
Ontario N6A 5C I
Mo.B. 1206
COMPASSIONATE ACCESS TO EXPERIMENTAL THERAPIES:THE CANADIAN
SAQUINAVIR COMPASSIONATE RELEASE PROGRAMME
Brabazon, C.I.*, Kreppner, J.**, Sussel, R.*, De Haa, L*, Oza, K.*, Moore,W*, Roy, D.***,
Conway, D****, Fauchere, S.*****. *Member CAC, CTN,Vancouvet **CHS, Ontario,
***IRCM, Montreal, ****M.D.,Toronto, *****Roche, Canada
Issue: Many people living with HIV/AIDS view compassionate access to experimental therapies as an ethical responsibility, while manufacturers see it as discretionary
Project: A committee of PLWHIV/AI, ethicists, and staff from the Canadian HIVTrials
Network and industry representatives from Roche Canada worked for several months on a
compassionate release programme for saquinavir.The goal was to develop a system to allocate a very limited amount of product to those people with AIDS in greatest need.
Results: An operational definition of compassionate access was developed by the committee.The committee also agreed on a tiered system of drug allocation.Throughout this
process, the date of product availability continued to change and the amount of product to
be released remained uncertain. Between 90 and 100 Canadians received saquinavir
through the compassionate release programme in the first series of allocations. Presently
approximately 1,000 Canadians are registered for the programme.
Lessons Learned: Community and industry can work together to develop criteria for compassionate release of experimental therapies. In the case of saquinavir, a huge amount of
time and energy was devoted to this process and two community members (K. Oza and L
De Haan) died before the process was completed. It is hoped that the system developed
for saquinavir can be used by other companies as a model for compassionate release programmes. As a result of this experience, it is recommended that a compassionate release
programme be a part of the drug development process in all clinical trials.
C. Brabazon, 3445 W Ist Ave,Vancouver, B.C.V6R I G6 Telephone: [phone]
Fax: [phone]
Mo.B. 1207
PSYCHOLOGICAL ISSUES AFFECTING PHYSICIAN'S COMMUNICATIONS TO
PATIENTS ABOUT FIRST AIDS DEFINING DIAGNOSES.Henshaw, P*, Petrak J**, Hedge B*. *St. Bartholomew's Hospital, **Royal London Hospital,
London, England
Objective: To evaluate the extent doctors delay telling patients they have AIDS and factors
that determine what the patient is told about the significance of the diagnosis.
Method: Medical notes of 50 patients with AIDS (reported to UK CDC) were reviewed.
Dates of AIDS Defining Illnesses (ADI), dates patients were informed of ADIs and time differences were calculated. Qualitative information revealing what was discussed with the
patient, factors influencing the timing of communication and involvement of mental health
professionals were assessed.
Results: Initial results (N=-20) indicate that specific diagnoses are communicated to the
patient promptly (85%). Only 25% of the medical notes explicitly reported that the physician had discussed the significance of the diagnosis as an ADI. In 20%, discussions about
AIDS occurred I-2 weeks after the specific diagnoses. In 55%, there is no indication what
the patient was told or understood. 45% were referred to a mental health professional
prior to diagnosis while 30% were subsequently referred. Qualitative information suggested
that physicians considered the following factors when they communicated ADIS' physical
health, psychological health, patient's knowledge of HIV, clinical/ academic usefulness of the
concept of AIDS. Physicians used alternative phrasing and words such as advanced HIV disease and severely compromised immune system to convey the significance of the diagnoses.
Conclusion: Physicians have no hesitation in communicating specific diagnoses such as KS or
PCP but commonly question the clinical usefulness of the term AIDS. It would appear that
they communicate the medical significance of first ADIs but use alternative terms to do so.
They clearly ensure that wider support is also available to the patient.The differences in the

classification systems between countries indicates wider disagreement about the concept of
AIDS at an academic level. Further studies of factors affecting the physicians decisions on
this issue are needed. Ethical issues about continued use of the term AIDS are discussed.
Mr Philip Henshaw, Andrewes Unit, King Gearge V Block, St. Bartholomew's Hospital,
London ECIA 7BE, UKTel: 0171 601 7827: Fax: [phone]
Mo.B. 1208
CLINICAL FEATURES OF HIV- I/2-SEROPREVALENCE AMONG SURGICAL AND
INTERNISTIC CASES AT A HEALTH CLINIC IN WESTERN UGANDA
Schmalzbauer, Edith*,Tibananuka, S.**, Bronn, C.***, Froesner, G.G.*. *Max von
Pettenkofer-Institute of the Univ.of Munich, 80336 Munich, Germany **Bujumbura
Dispensary, Hoima, Uganda, ***Institute for Medical Virology of the Univ. of Zurich, Nat.
Centr f Retroviruses, 8028 Zurich, Switzerland
Objective: Determination of HIV I/2-Seroprevalence, risk factors and clinical features among
Surgical and Internal Cases at a Health Station in Western Uganda.
Methods: Altogether 243 (162 Trauma- and 81 General/Abdominal-) Surgical outpatients
and 67 I Internistic in-and outpatients were examined, registered and screened for HIV I/2
by Elisa, followed by confirming Western Blot. Outpatients additionally were tested for
syphilis antibodies by treponema pallidum haemagglutinations test. Age ranged among outpatients from 15-69 and among inpatients from 0-69 years, including children. Risk factors
like blood transfusions, unstable partnerships, frequent traveling were inquired and statistically evaluated.The main target was to investigate the incidence of HIV- I/2 among different
diseases of admission at the health station.
Results: Diagnoses with highest incidence of HIV- I infection were intestinal Kaposi's sarcoma, abdominal TBC and peritonitis in General-and stab- and gun-injuries in EmergencySurgical Cases. Patients with multimorbidity, diarrhoea, veneral diseases and weakness
showed the highest HIV-positivity among Internistic out-and inpatients. HIV- I seroprevalence in Surgical outpatients was 26,8% (trauma 12,96%, general 54,3%), in internistic outpatients 27,8% and inpatients 44,96%. A Lues/HIV- I-double infection rate of 13,5% was found
in outpatients. One confirmed double infection of HIV- I and-2 was detected. Concerning
age ranges seroprevalence of HIV- I in outpatients reached two peaks, the first at 25-29
(males 20-24) and the second at 40-49 years. Highest HIV- I -incidence among inpatients
was found in women at the age of 30-39 and men 40-49.9,1% of outpatients and 16% of
inpatients, of whom 35,4% and 46,8%, respectively, were HIV- I positve, had got blood transfusions during their lives.
Conclusions: We found some Surgical and Internistic features to be more frequent when
associated with HIV-infection, higher HIV- I-prevalence in women than men and one confirmed HIV- 1/2 double infection in Uganda. A ranking list of diagnoses associated with HIVinfection of this study was drawn.
E. Schmalzbauer, Max von Pettenkofer-Institute, Pettenkoferstr. 9a, 80336 Munich, Germany
Tel.:[phone], Fax: [phone], email: ediths@m340 I.mpkmed.unimuenchen.de
Mo.B. 1209
NATURAL HISTORY OF DUAL INFECTION WITH HIV- I AND HIV-2
Saple Dattatray*, Maniyar J.K.*, KurimuraT**, Curmally F.*. *G.THospital, Grant Medical
College, Bombay University** Osaka University
Aims: Dual infection with HIV- I and HIV-2 is well known to occurThere is however very
little literature on its natural history in India.To study natural history of dual infection with
HIV- I and HIV-2 in Bombay
Methods: All subjects were selected from patients presenting with STDs or skin and/or systemic markers of HIV, during April I1994 to November 1995 and were confirmed by ELISA,
WB, and some by PCR. Followup examination were conducted every three months or/on
each subsequent illness whichever was earlier.
Results: Total patients were 1290, of these, HIV- I 97 I, HIV-2 59 and HIV- I +HIV-2 260. Of
260 dual infection, I 60 were males and I00 females. Minimum age was I15 years, maximum
47 years, mean was 25 years. 117 were married and 143 unmarried. Unskilled were 240
and skilled 20.The main route of transmission was heterosexual (95.06%). Of total dual
infection, I 20 were asymptomatic, 72 ARC, 75 AIDS. GUD was 15.63%, Secondary Syphilis
4. I 1%, Oral Candidiasis 13.17%, H. Zoster I I.5%. Psoriasis, K.S., Atopic were not seen.TB
was 22.33% and PCP 0.82%.
Conclusions: Dual infection constitutes 20% 2.The main route of transmission is heterosexual. 3. Individuals of 2nd and 3rd decade and Unskilled were common. 4. GUD, Oral
Candidiasis, Herpes ZostetTB were common. 5.This study will be useful for the control,
vaccine production and management of HIV.
Saple Dattatray, II/C, Oliver Mension, Mogal Lane, Mahim, Bombay-4000 I16.
Tel.: 9 I -22-4379604 Fax: 9 I -22-4379604, 2083184, 2062847 India
Mo.B.1210
CLINICAL PROFILE OF PERSONS WITH SINGLE AND DUAL HIV-1/2 INFECTIONS
IN BOMBAY
Hira Subhash*/***, Oberoi, C**, Gharpure, H***, Dupont, H*. *AIDS Research & Control
Centre (ARCON), Bombay & The University of Texas, USA; **JJ Hospital, Bombay; ***MGM
Medical College, New Bombay India
Objectives: To determine prevalence of single and dual HIV- 1/2 infections and their clinical
profiles.
Methods: One hundred and eighty consecutive patients attending ARCON referral outpatient service at JJ Hospital in Bombay were recruited in the study in October I995.Those
testing HIV-I/2 reactive with ELISA were classified as single or dually infected with HIV- I
&/or 2 using Serodia, LAVBLOT- I and LAVBLOT-2. Determination of HIV- I &/or HIV-2 was
based on WHO/CDC guidelines.
Results:

CI'
O
L
a)
0
U
C
cO0
N
a)
U
c)
a)
O
0
U
4
c
0
-
c
x
90