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

Mo.C.1555 - Mo.C.1559

Monday, July 8, 1996

case detection significantly greater than the average annual increase from al stes or bined
(p<0.01). Analyses also revealed changes in the distribution of risk behavior over tirie.
Notably from 1992 through 1995 heterosexuals reported the largest incree in HI V rinflections (average yearly i ncrease: 52~2%) compared to the average reports farom,ll sk
groups (p<0.05).
Discussion:The increase in the use of non traditional HIV testing services may be attributable to various possibilities: I) an increase in the availability of non traditional testing
sites, 2) a decentralization of HIV testing from pre-designated sites to local medical clinics
and provincial/county hospitals, and/or 3) an increase in particular groups seeking HIV
tests from non-traditional testing sites.Tracking of HIV cases and behavioral characteristics
can provide valuable information for not only evaluating current HIV surveillance programs, but also adjusting medical education towards detecting HIV signs and symptoms in
non -traditional settings.
Yvonne Gail Lin, NTU 1 JIng Fu Guest Hall, Room 409, No.1I, Chang-Teh StreetTaipe.,
Taiwan. Tel: 02-3 12356x8355; Fax: [phone]; email: [email protected]
Mo.C.1555
MONITORING THE AIDS INCUBATION PERIOD DISTRIBUTION IN THE UK
THROUGH A REGISTER OF HIV SEROCONVERTERS
Porter, Kholoud*. on behalf of the Steering Committee of the UK Register of HIV
Seroconverters. " MRC HIV Clinical Trials Centre, UCLMS, London, UK.
Objectives: To monitor changes in the distribution of intervals from HIV seroconversion to
onset of AIDS and to death and to describe associated factors, by establishing a national
register of persons with well estimated HIV seroconversion dates.
Methods: Clinicians throughout the UK caring for HIV positive individuals and laboratories
performing HIV testing were asked to identify all individuals with a history of a negative HIV
antibody test within three years of their first positive test (definition of a seroconverter on
the Register), including those who have died, transferred to other centres or who become
lost to follow up. Baseline and follow up information collected annually includes: sex, ethnic
group, route of HIV transrmission, latest CD4 count, details of therapy and prophylaxis, AIDS
defining events and vital status.
Results: To 3 1/1 2/95, 2004 seroconverters (excluding haemophiliacs) were identified and
information received on 1508. Of these, 1330 fulfilled the eligibility criteria and have seroconversion dates between 1983 - 1995. Most (77%) were infected through sex between
men, 10% through sex between men and women, I I% through injecting drug use, and 2%
through other or undetermined modes of transmission, compared to 65%, 19%, 12% and
4% respectively among reported cases of HIV infection in the UK.
Conclusion: The Register succeeded in accruing information on a large number of seroconverters, and carefully definirng the time when each individual patient enters the 'risk set'.This
is used in estimating the cumulative probabilities of developing AIDS or dying using KaplanMeier estimation. Preliminary analysis of factors associated with the distribution of times
from seroconversion to AIDS and to death using Cox proportional hazard models are
ongoing and results will be presented.
Kholoud Porter, MRC HIV CTC,The Mortimer Market Centre, Mortimer Market, London
WC IE 6AU,. UK.Tel: 44 171 I 380 999 I Fax: 44 17 I 380 9972, e-mail: [email protected]
Mo.C.1556
SURVEILLANCE OF HIV ANTIBODY TESTING IN AN URBAN ACADEMIC MEDICAL
CENTER
Tedaldi, Ellen M, Miller N,Tseng J, van den Berg Wolf MG, Moyer D. General Internal
Medicine,Temple University, Philadelphia, PA, USA
Objectives:To determine the extent of non-notification of patients' HIV test results and to
determine the referrals to HIV specific care for inpatients and outpatients.
Methods:The records of all patients who tested positive for HIV antibody between the
period of July 1994 and October 1995 were reviewed retrospectively to deternmine:
I. if the patient received notification of the test result; and 2. if the patient was referred to
any approprate medical clinical site for further HIV related care. Referral options were:.
a.) Yes = referral made and patient is currently in care; b.) No - no referral made:or
c.) No show - a referral was made but patient never showed for the appointment.
Results: A total of 3438 HIV antibody tests were done on medical, surgical and psychiatric
patients. Obstetric patients were excluded as testing is done in another site.There were
174 positive HIV tests (65 out-patients, 109 inpatients, 4 repeats) for a seroprevalence rate
of 5.0%. total of 28 patients who are part of a special family clinical care program had
repeat I, esing to verify the referral diagnosis.They were excluded from this analysis.
Notificatior of results was given to 70 inpatients (88%) and 27 outpatients (73%). No notification was found for- 9 (I 1%) of the inpatients and 14 (27%) of the outpatients. Referral
results were as foilows: Inpatient-Yes 24 (29%); No 28 (35%); No show 20 (25%). Eight
patients died, I went to a nursing home and 9 have unknown status. Of the outpatient
refer rals:Yes 31 (63%): NoI 8 (I 6%) and No show 6 (12.2%). One patient died and 3 have
u kr nown status.
Conclusion: I.) There is ' yinifcant number of patienits who have no dociumentation of
receiving HIV antibody results especially in the out-patient group. 2.) fhe majority of HIV positive patients tested in the hospital do not receive adequate referrals for post-discharge care.
E.M. Tedaldi, 3401 North Broid Street, Philadelphia. PA 19 140 Telephone: 2 I5 707 7901
Fix 215-70/ 3644 ninai: etcdaidifovm.temple edcr
Mo.C. 1557
AIDS CASE REPORTING:A PROGRAM TO IMPROVE EFFICIENCY
Dykeman, M.,Jasek J, Allen S. The Cook County HIV Primary Care Center, Chicago, IL, USA
Issue: The accurate and timely reporting of AIDS cases to the U.S. Centers for Disease
Control (CDC) continues to present formidable organizational and financial challenges to
provider agencies.
Project: The 1993 Expanded Surveillance Case Detnition for AIDS necessitated that our
orgarization, one of the largest public providers of health care to HIV/AIDS clients in the
Midwestern United States, streamline its efforts at gathering and reporting AIDS case data.
Straityies included deve!aping a specialized computer database, centralizing demographic
and redical i f 'ratio- ', fining staff roles visa vis reporting, and increasrng linkages
between our site aid outsi e surveilance agencies

Results: Our agey ro,,v it-ports approximately 30 outpatient and 50 inpatient AIDS cases
per month, which IepresenIs the highest ratio of outpatient to inpatient reporting in our
area.The region! I iAI.)S Surveillance Office does less active follow-up at our site than
ever before (dcv.n fo l5,i. of cases in 1992 to only 5% in 1995).
Lessons Learned: (er:.,lr, t on of information, in conjunction with a team approach, clearly expedites the rep'r:,n fp ocess. However, numerous barriers remain, including: I) duplication of reporting between agencies uses scarce resources. 2) inconsistencies in charting
risk factors and diagnoses limit report validity 3) substantial costs for data collection and
reporting. More effcient methods of reporting HIV/AIDS information seem essential.
M Dykeman, 1900 W Polk Street, # I 25 1, Chicago, IL USA 606 I 2 Telephone: [phone],
Fax: [phone]
Mo.C.1558
ESTIMATING THE NUMBER OF AIDS-DEFINING OPPORTUNISTIC ILLNESS
(AIDS-Ol) DIAGNOSES FROM 1993 AIDS SURVEILLANCE DEFINITION DATA,
UNITED STATES
Karon, John M, Green Timothy A, Hanson Debra L,Ward John W Centers for Disease
Control and Prevention (CDC), Atlanta, Georgia, U.S.A.
Objective: To present and evaluate a method for estimating the number of AIDS OI diagnoses using data collected under the 1993 AIDS surveillance definition in the United States
and to use these estimates to monitor temporal trends.
Methods: The estimated number of AIDS OI diagnoses (dxs) in a time period is the sum of
(I) the number cf AIDS cases reported based on AIDS-OI dxs made in that period and (2)
the estimated number of such dxs in that period among persons with AIDS reported
based on CD4 criteria.We estimated the second term from the probability distributions of
the time from a CD4 count in given ranges to AIDS-OI dx (data from the CDC Adult and
Adolescent Spectrum of Disease [ASD] Project).We evaluated the effect of 2 other factors: deaths before AIDS-OI dx (approximately 5% of persons meeting the CD4 criteria,
based on data from the ASD Project), and persons reported with AIDS based on the CD4
criteria who had an (unreported) AIDS-OI diagnosed by the date of this CD4 determination (approximately 10% of persons reported based on the CD4 criteria, according to data
from an evaluation of AIDS surveillance).
Results: The proportion of U.S. AIDS dxs based on the CD4 criteria increased from I 2%
for dxs made in i991I to 52% for dxs made in 1994.The median time from meeting the
CD4 criteria to AIDS-OI dx was I 8 months among persons observed in the ASD Project.
The estimated number of AIDS-OI dxs increased by I 1% in 1992, 3% in 1993, and 6% in
1994 from the previous year. In contrast, the number of AIDS dxs based on Ols decreased
17% from 1991I to 1994. Including the effects of death before AIDS-01 dx and of unreported concurrent AIDS-OI dxs in our model increases the estimated number of AIDS-OI dxs
in each calendar quarter during 1990-1994, but by <4% in each quarter.
Conclusions: Increased use of the CD4 criteria caused the apparent decline in the number
of AIDS-OI dxs. in contrast to the actual number of persons newly dxed with an AIDS-O,
which increased during 199 I-1994. Deaths before AIDS-01 dx and unreported concurrent
AIDS-OI dxs among persons reported based on the CD4 criteria have relatively little effect
on estimates of the number of persons newly dxed with AIDS-OIs.
John M. Karon, 1600 Clifton Rd., N.E., E-48, Atlanta, GA 30333. USA,Tel: [phone]
Fax: [phone] email: [email protected]
Mo.C.1559
HIV AND AIDS SURVEILLANCE IN COLOMBIA.
Garcia Ricardo * **, Klaskala W.**, Angulo C.*, Baum M.**. * Ministry of Health, Colomnbia
** Fogarty International Training Program.
Objective: To describe the epidemiology of HIV/AIDS in Colombia based on routinely collect
ed health surveillance data and sentinel studies conducted among specific population groups.
Methods: Routinely collected data on HIV surveillance from regional and national AIDS
prevention programs, and findings from the seroprevalence studies performed in blood
banks and sentinel population groups over a period of 5 years were analyzed according to
their demographics, mode of transmission and risk category
Results: As of July 1995, Colombia was ranked third among Latin-American continental
countries in cumulative number of reported AIDS cases. Annual AIDS incidence rate (per
100.000) has increased from 2.3 in 1990 to 3.4 in 1995. At the same time, the number of
HIV infections has reached I 3.000, with an annual incidence of 8.6 per 100.000 compared
to 4.3 in 1990. Of those, 83% were males and 17% females. Over half of documented HIV
infections have occurred among young adults between 15 and 34 years of age.There is an
increasing proportion of women positive for HIV.This trend is supported by the male to
female ratio which was 37:1 in 1987, 12:1 in 1988 and 8:1 in 1994. In some regions this
ratio is even lower, including the Atlantic coast of the country (4:1). In I1994, 68% of reported HIV infections were contributed to heterosexual transmission, compared to 40% in
1987.The National AIDS Program estimates that the prevalence of HIV infection in the
general population is about 0.25%.
Conclusions: Colornmbia is experiencing a second phase of the HIV pandemic, in which the
heterosexual transmission appears to be the predominant mode of the spread of HIV. A
changing pattern from homosexual to heterosexual transmission is being observed.The
results point towards the young adults as the most vulnerable subjects to the AIDS epidemic. More specific clinical based sentinel studies are necessary to assess the magnitude of HIV
infection in Colombia.
Garcia Ricardo, 1400 NW I 0th Avenue 10th floot Dominion Tower Department of
Epidemiology and Public Health, University of Miami, Florida 33136. USA.Tel: [phone].
Fax: [phone]

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