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

Tu.B.301 - Tu.B.313

Tuesday, July 9, 1996

of color and acquiring HIV in association with substance abuse. Clearly, the political will
that has been so well mobilized in making progress against HIV may erode given these
demographic changes Finally the system of are in which we work has ch-nged even faster
than the epidemic has spread Great strider in reorganizing the incentives of healith care
are reducing costs and encouran ficus on riommunity-based care that was long over
due. AIDS care, however, does not always fit well n cost centered models. AIDS care is
complex, educating patients takes time, and the same therapies that are so promising are
also expensive. What are the incentives that would!cad aI medical care organization to
develop excellence in the care of an expensive di sease, unless the associated costs are
anticipated and shared
The new world of AIDS is a cha llenpg g one, and our success s not guar anteed. We, never
theless, hold hope that the gans we are making soientifically will be able to be used for the
benefit of our patients; those today, as well as tomorrow.
PA Volberding, SFGH Ward 84, 995 Potrero Ave., San Francisco, CA, 94110 USA
Tel: [phone] x84232 Fax: [phone] E-mail: [email protected]
Tu.B.30 I
THERAPEUTIC ISSUES IN LATIN AMERICA
Cahn, Pedro. Hospital Juan A. Fernandez & HUESPED Foundation, Buenos Aires, Argentina
Latin America is a wide region with big differences in levels of development, socioeconomic
situation and health care services. Some opportunistic infections like PCP show similar incidence as in the developed world, while others like histoplasmosis, tuberculosis, and toxoplasmosis are more frequently diagnosed
Regional diseases like Chagas, leishmraniasis, and endemic mycoses are increasingly seen in
HIV patients. These diseases frequently are misdiagnosed as toxoplasmic encephalitis, tuberculosis, and other opportunistic infections.
Lack of facilities for isolation forTB patients generates high risk for in-hospital transmission.
At least one large outbreak of multidrug resistant TB has been confirmed in Latin America.
In different countries the availability of diagnostic tools and drugs for treatment of these diseases is not uniform, reflecting the unequal access to health care in this region. Last but not
least, a high proportion of HIV patients are diagnosed in late stages of the disease, making
primary prophylaxis impossible for therm. Improvement in prevention and care is mandatory in order to avoid unnecessary levels of suffering, disease and mortality in this region.
P Cahn, Gasc6n 79 (I 18 I), Buenos Aires, Argentina Tel: 54 1-98 I-1828 Fax: 54 I -983-7774
Tu.B.304
THERAPEUTIC ISSUES IN ASIA
Sirisanthana Thira. Faculty of Medicine, Chiang Mai University Chiang Mai,Thailand
The relative incidence of various types of opportunistic infection (01) varies among differ
ent geographic locations. In Thailand, the four most common Ols are tuberculosis, crypto
coccosis, Pneumocystis carinii pneumonia, and penicilliosis (infection caused by an emerging
pathogenic fuingus, Penicillium marneffei).The appropriate management of DI that is endemic only to a particular region, for example penicilliosis in Southeast Asia, needs to be determined by medical workers in that area. Study to find the optimal prophylactic and therapeutic regimens needs to be carred out.The cost of treatment of many Ols is a major
obstacle to management.Whether borne by the government or by the patients themselves,
the cost of treating an episode of cryptococcal meningitis, for example, is astronomical
when compared to the gross domestic product per capita. Partially for this reason, many
patients were lost to follow up and thus did not receive optimal medical care.The task of
caring for a large number of AIDS patients adds burden to the already inadequate health
care infrastructure.
Priority has already been,ven to the prevention of HIV infection, but persons who have
already been infected also need to be adequately taken care of.These individuals should be
encouraged to come into the health care system early so that health education, psychosocial support, as well as prmary prophylactic agent(s) may be given. Since this is best done at
the community level, the health care system should be decentralized. Local health care
workers, including general praictitioners should have more training in caring for these
patients. At least part of the cost to the patients will decrease with easier access to the
local health care system. Study of the prophylactic and therapeutic use of less expensive
drugs shoiuld be caried out and more budget should be allocated to improve the health
care infrastructure.
T Sirisanthana, Faculty of Medicine, Chian g Mai Uiniversity, Chiang Mai,Thailand,.
Fax: [phone]; Email: sinrsan(tcmu.chiangrnai.ac.th
Tu.B.310
HIV DISEASE PROGRESSION AND MEDIAN SURVIVAL TIMES IN A RURAL
UGANDAN COHORT
Morgan, Dilys, Malamrba S, Okongo M, Mayanja B, Maude G,Whitworth J. Medical Research
Council Programme on AIDS/Uganda Virus Research Institute, Entebbe, Uganda
Objectives: To determine disease progression rates, describe AIDS-defining illnesses and
estimate survival times to AIDS and death in HIV infected individuals according to their initial WHO clinical stage.
Methods: 179 FIV-infected persons were recruited from a rural population of approximately 5,000 adults in SW Uand t 93 were seroprevalent cases identiied in 1990, and 86
were incident cases who seroconverted over the subsequent ive years. Participants attended the study clinic every three morntis for a detailed medical interview, full physical examination and basic laboratory irnvestigatrions For each visit they were categorised according to
the clinical and performance scale of the WI-IO staging sy tem using a computer algorithm.
Survival times were estimated by the Kapan Meier method.
Results: We have now accrued a total of 437 person-years of observation. At recruitment,
4 of the seroprevalent rases and I seroincident case were assessed as WHO stage 4
(AIDS). During ive years, a urther 37 (39.8%) seroprevalent and 8 (9.3%) seroincident
cases progressed to AIDS. The main reasons for this were: HIV wasting syndrome (17 seroprevulent, 6 seroincdent). oesophageal candidiasis (I 4, 2), rucocutaneous HSV infection >
I mth (6, 0) and Kaposi 's sarcoma (5, l).The median times to AIDS from stages 1, 2 and 3
were greater than 4.5, 3.3 and 2.4 years respectively Fifty-four deaths occurred (47 sero
prevalent and 7 seroincident cases) over this period. Median survival times to death were:
greater than 4.5 yemrs. 4. 1, 2.7, and 1. I years for those in stages I, 2, 3 and 4 respectively.

Conclusions: Resuts i,)r r tris on-going cohort study suggest that HIV disease progression
and median surival t m es,, this rural African population are shorter than in other published studies.The n ai, s for progression to AIDS were HIV wasting syndrome and
oesophageal cardia..
Dr U Morga,,Ml t 1r PI Pr. Box 49, Entebbe, Uganda Tel: [phone],
Fax: [phone] /, 1 maF onrc(amukla.gn.apc.org
Tu.B.31 I
CLINICAL PRESENTATION, RISK CATEGORY,AND HIV-I SUBTYPES BAND E IN
1241 HIV/AIDS PATIENTS IN THAILAND
Limpakarnjanarat, Khanch iCTansuphasawadikul S" Mast TD ' tiravivongs A*,
Kita aporn D,i,Tanchanpong C", Kaewkungwal J ', Nawatanakul T,Young
N ', Mock P', Nieburg P ** *HIV/AIDS Collaboration, Nonthabun,Thailand
*Bamrasnaradura Infectious Disease Hospital (BIH), MOPH, Nonthaburi; **CDC,Atlanta,
USA; ****Mahidol University, Bangkok: ***'"*Rajamangala Institute of Tech., Bangkok.
Objectives: To describe and compare clinical presentation of HIV/AIDS patients infected with
two distinct HIV I subtypes, B and E, at BIH, a public tertiary care center near Bangkok.
Methods: All adult (> 4 yrs) patients admitted to medical wards at BIH from Dec.'93 to
June 95 were offered voluntary HIV counseling and testing with informed consent. Data
were collected or all HIV+ patients admitted for the first time. Infecting HIV I subtypes
were determined by highly specific V3 loop peptide EIAs.
Results: Of 4930 patients tested, 1241 (25%) were HIV+. Most HIV4 patients were male
(87%); risk catego y was sexual for 84% and injecting drug user (IDU) for 16%.The most
common clinical problems were tuberculosis (TB) (25%), cryptococcal meningitis (23%), and
prolonged fever (I 5%). IDUs were more likely (p<0.0S) to have TB, and bacterial pneumonia and sepsis: and were less likely (p<0.05) to have cryptococcal meningitis and
Pneumocystis carinii pneumonia. HIV I subtype could be determined for 1125 (9 1%): 970
(86%) were E anc 155 (14%) were B. Subtype E was found in 94% of patients with sexual
risk and 26% of IDUs (p<0.001); IDUs with E were younger than IDUs with B (p<0.0I1) In
multivariate analyses controlling for gender, age, and risk category subtype E was associated
with lower (<I500/pL) lymphocyte counts (OR -- 1.9; 95% CI, I. I - 3.3) and cryptococcal
meningitis (OR -= 2.7; 95% CI, I1.2 6.5). In analyses among IDUs only subtype E remained
associated with lower lymphocyte counts (OR = 2.9: 95% Cl, I. I- 7.4).
Conclusions: Anmong HIV/AIDS patients in Thailand, IDUs present with different opportunistic infections Than non-IDUs. Infecting HIV-I subtype may independently influence the
course of immune suppression and clinical disease
Khanchit Limpakarnjanarat, HIV/AIDS Collaboration, 88/7 Soi Bamrasnaradura,Tivanon
Road, Nonthaburi II 000,Thailand.Tel: [phone], Fax: [phone]
email: kx [email protected]
Tu.B.312
DETECTION AND QUANTIFICATION OF HIV-I SUBTYPES WITHIN LARGE POPULATIONS BY SEROLOGY, HETERODUPLEX MOBILITY ASSAY (HMA) AND SEQUENCING
Rachanee Cheingsong Popov, A Bobkov, S Lister, M Garaev, BR Santos, K Arlyoshi, H
Whittle, P Kaleebur, J Weber the WHO Network for HIV I isolation and characterization St
Mary's Hospital Medical School, London, UIJK.
Objective:To produce and validate an algorithm for the efficient subtyping of HIV-I in
diverse populations, and to apply the algorithm to study strain variation in incidence, trans
mission and naturIl history of HIV I subtypes.
Methods and Design: Serum from HIV I infected subjects from diverse locations were irst
screened by subtype specific V3 peptide ELISA. HMA was performed in order to validate the
serological results '5%) and in serologically non-reactive cases.V I -V5 env sequence analysis
was performed when HMA gave negative or ambiguous results. HIV I subtypes were
analysed by risk factors for infection and other epidemiological data.
Results: The specifcity of peptide serology was established using 120 sera from genetically
identified subjects from the WHO network representing subtypes A-E.The algorithm was
then applied to large number of unknown subjects fromThe Gambia, Brazil and Russia. In the
Gambia, we demonstrated that several HIV-I subtypes including a recombinant HIV I strain
exist (A,BC, D, F, and C/G): that subtype A predominates, and is rising from 55% in 1989 to
65% in 1992. In Brazil. peptide serology has shown subtype C infection in intravenous drug
users, whereas subtypes B and B are prevalent among homosexual and bisexual men. In
Russia, multiple HIV I subtypes (ACD,GH) were evident in heterosexual men and women;
however, subtype B is associated with homosexual men and subtype G is prevalent among
children who were infected by a nasocomial infection in the south of Russia.
Conclusions:The algorithm allows population-based screening to be undertaken so that
epidemiological questions on the significance of genetic subtypes may be addressed; it
also enabled us to identify the new variants subtypes such as C and H (Russia) and C/G
(The Gambia)
Dr R Cheinsong-Popov, St Mary's Hospital Medical School, Praed St. London W2 I NY, UK
Tel: [phone] Fax: [phone]
Tu.B.313
HIV-2 AS A MODEL FOR LONG TERM NON-PROGRESSION
Marlink, Richard*, Traore **,Thior tI, Siby T*, Ndoye I***, Mboup 5**, Essex M*, Kanki P'.
*Harvard AIDS Institute, Harvard School of Public Health, Boston, USA. * BactenoVirologie, Universitd C.A. Diop, Senegal. **institut d Hygiene Socale, Senegal.
Objective: To predict the proportion of HIV2 infected individuals who may be long term
non-progressors as compared to HIV I.
Methods: We have clinically followed 143 HIV-2-positive and 105 HIV I -postve women
from I985 through I995 In a cohort of registered sex workers in Dakan Senegal.
Examinations, HIV and STD screening, and CD4 counts have been routinely obtained.
Results: Whether seroincident or seroprevalent cases were examined, we noted that HIV2-positive women developed abnormal CD4 counts at a rate of about approx. I% per year
whereas HIV I-positive women developed abnormal CD4 counts at approx. 10% per year
The incidence of HIV 2 AIDS overall was 0. I 5/ 100 PYO (95% Cl - 0.02 1.029) and HIV I
AIDS was 3.38/ 100 PYO (95% CI - 1.8 18-6.279), with the following Kaplan-Meier survival
analysis comparison of HIV 2 versus HIV I.

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