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

Track B: Clinical Science
Conclusions: Primary care clinics providing services to patients that are HIV + should routinely screen for STDs, regardless of patient symptoms. Recent sludies indicate that HIV
transmission is increased in the presence of STD infection. STD cotrol has beeni found to
be an effective method for HIV prevention in the general population.The importance of
theoretical increased risk of mucosal tract infections with these p t ogens and the potential
for increased HIV transmission warrants routine screening of HIV + patients. Basing STD
screening protocols in the primary care setting on symptoms is not adequate. Our results
suggest the need for routine STD screening of these patients.
Peter Anthony Leone, 10 Sunnybrook Rd., Raleigh NC 27620 Telepione:919-250-3999
email: palOO7@(med.unc.edu
Tu.B.2146
ROLE OF PULMONARY CONSULTATIONS IN DIAGNOSIS (AND TREATMENT) OF
HIV/AIDS PATIENTS
Donatelli Michael*, Steinbock, C, Chopra, A*, Sharp,V*. *The Spellman Center for HIV
Related Diseases, St. Clare's Hospital, New York City, NY, USA
Objective: To evaluate the utilization of pulmonary consultations in the iranagement of
HIV/AIDS patients treated in an urban AIDS treatment center:
Methods: A retrospective review was conducted on 90 randomly selected records of
HIV/AIDS patients where pulmonary consults were performed by any nne of 3 pulmonologists between November 1994 and August 1995.Total sample represented 58% of all HIV
pulmonary consults done in that period. A comparative analysis of consult response time,
impression, recommendations, procedures and diagnostic yield between the three consultants was performed.
Results: Mean length of stay for patients with pulmonary consults vs those HIV/AIDS
patients without was 36.8 days vs. I 8. I. Most frequent indications for puilmonary consult
were abnormal chest x-ray (58%) and positive gram stain (29%). Mean consuit response
time was 1.5 days.The clinical impression was to rule out: bacterial pneumonia (48% of
records), pneumocystis carinii pneumonia (47%) and tuberculosis (47%). Of 49 (54%) cases
where a diagnostic procedure was requested 39 (80%) were performed (7 refused, 3
deferred for tx response).The most common diagnostic procedure performed was bronchoscopy (69%). Of all cases reviewed receiving a pulmonary consult, a definitive diagnoses
was found in 37% and a presumptive diagnosis in 63%. Comparative review of the three
consultants revealed that the consultant who performed the most diagnostic procedures
(67% of all procedures) had the highest number of definitive diagnoses (57%).
Conclusions: This review revealed that initial clinical impressions of one or more pathogens
were supported by pulmonary consultation and that bronchoscopy is most effective in
determining a definitive diagnosis. Pulmonary consultations are clearly essential in the management of HIV/AIDS patients where length of stay data suggest such cases have a greater
severity of illness.
Michael Donatelli, 4 15 West 5 I st Street,The Spellman Center for HIV Related Diseases, St.
Clare's Hospital, New York City NY 10022; USA
Phone: (2 I 2) 459 8409 Fax: (2 I 2) 459 8489
Tu.B.2147
SELECTED DEMOGRAPHIC, FUNCTIONAL STATUS,AND CLINICAL
CHARACTERISTICS OF RESIDENTS IN THE THREE DIFFERENT LONG TERM CARE
MODELS FOR PEOPLE WITH AIDS AVAILABLE IN NEW YORK STATE
Hos, David*, Agins, B., Chestnut,T, Devore, B., Chrost, C. NewYork State Department of
Health, AIDS Institute.
Issues: Persons with AIDS requiring long term care placement have not been well characterized.
Project:: New York State has over 1050 beds in long term care facilities for persons with
AIDS with three models of HIV long term care: traditional skilled nursing facilities (SNF),
drug treatment therapeutic residences for persons with AIDS (Dtx), and lower acuity residential care facilities (HRF). Demographic, social support, clinical, mental status, and activities
of daily living(ADL) data on patients in these different settings were compared.
Results: Residents of SNFs, when compared to those of Dtx and HRF facilities, more often
lived alone prior to admission, (38/18/7%, respectively), were made (751/62/71% respectively), and were older (41.9/39.7/37 years respectively).They were more likely to be demented
(43/14/2% respectively), medically unstable (56/I 1/3% respectively) receiving fewer numbers
of meds (5/10/7 respectively), and less likely to have ADL independency (45/84/96%
respectively). Residents in SNFs also had shorter lengths-of-stay(84/28/ 94 days respectively) and were least likely to be discharged to the community (14/I 7/70% respectively) than
residents of other facility types.
Lessons Learned: By having several models of nursing facility care, New York State can
serve distinct populations. More clinical resident data will be included for poster and temporal trends will be analyzed.
David Hoes, NYS Department of Health, AIDS Institute, 5 Penn Plaza. I st Floor; New York,
NY I0001, USA
Telephone: 2 I 2-613 2423 Fax: 2 I 2-613-4907, Email: [email protected] is
Tu.B.2 148
CLINICAL, PSYCHOLOGICAL AND BEHAVIORAL CHARACTERISTICS OF HIV
PATIENTS REPORTING LOW COMPLIANCE TO TREATMENTS.
Balestra P, Feri F., Galgani S.*, Narciso P., Pellicelli A.,Tozzi V., Zaccareli H., Visco Giuseppe.
Spallanzani Hospital, *S. Camillo Hospital Rome, Italy
Objective: To identify factors associated to a low compliance to HIV treatments in a group
of patients attending an infectious disease hospital in Rome.
Methods: One-hundred-five consecutive patients were anonimousy irter viewed, during the
second half of 1995, by a psychologist out from the usual setting.The standard interview
was aimed to assess compliance to the prescribed treatment.A partsicular Iocus has been
set to evaluate the compliance to antiretroviral drugs and cotrimoxazole prophylaxis.
Results: Four out of 105 patients (3.8%) refused the interview.The following distribution of

main variables was found in the remaining 10 I patients: I) Sex: 67.3% males and 32.7%
females; 2) risk factors: 32.7% heterosexuals, 31.7% intravenous dr ug users, 19.8% homosexuals, I 1.9% with unknown risk and 4.0% blood transfused; 3) age: 8.9% were <30 years old,
60.4% between 30 and 39 years and 30.7%>39 years; 4) CD4T cell count.

Tu.B.2146 - Tu.B.2152
44.6%<I00/mmc, 36.6%> 100<399 and 18.8%>500/mmc. Non-compliance to prescribed
treatment was reported by 54 patients (53.5%). A noncompliance was statistically related
to: a) patients with unknown risk for HIV (75.0%); b) with CD4+ lymphocytes
count< 100/mmc; c) treatments with more than 4 drugs; d) Cotrimoxazole prophylaxis
(84.6%).1he anti-retroviral drug most frequently associated to non compliance was
Didanosine (60.0%) respect to Zidovudine (54.2%) and Zalcitabine (50.0%). A multiple
logistic regression analysis showed a significant association of non-compliance with a CD4-+
count<I100/mmc (OR:4.7,95% CI:1.2 10.1) and Cotrimoxazole prophylaxis (OR:2.5,95%
Cl: 1 -5.8).
Conclusions: Reasons related to non-compliance identified during the interview may be
explained with: I) belief of ineffectiveness of the drug; 2) denial of the HIV stutus; 3) selfperception of side effects.The need of psychological support for HIV patients who receive
drugs and are followed in day-hospital is suggested by the results of our study
Visco Giuseppe, Spallanzani Hospital,Via Portuense 292, 00149 - Roma, Italy Telephone 39
6-3300597 Fax [phone] email [email protected]
Tu.B.2149
HOME CARE FOR HIV PATIENTS.AN ALTERNATIVE MODEL OF THERAPEUTIC
STRATEGY
Falciano MH, Salotti Alessandra. Bergami N., Rubino L., Errera G..Tchangmena O.B.,
Macedonio A.,Turbessi G. Dept. Infect. and Trop. Dis., La Sapienza University Rome, Italy
Objective: Home care for HIV patients (stage C) can be considered an alternative to hospital care.\/e evaluated the feasibility of this model and its advantages.
Methods: We analyzed the results of home care' for AIDS patients, followed in the period
from May to December 1995 at the Department of Infectious and Tropical Diseases of the
University of Rome "La Sapienza". We considered age, number of CD4+, Karnofsky index,
sex and number of necessary treatments.
Results: Seventeen patients (I I males and 6 females) were followed in home care. Mean
age was 34.2 years and the average number of CD4+ was 36.6 cells/mmc.The Karnofsky
index was from 50 to 60. At the beginning of the treatment the patients were affected by
the following diseases: 9 Cytomegalovirus retinitis, 2 Candida oesophagitis, I cerebral toxo
plasmosis. I wasting syndrome, 2 encephalopathy, I cryptococcosis.The mean time elapsed
since diagnosis of C stage and the request of home care treatment was 7.4 months.The
total number of home care interventions was 682 with an average value of 32 per patient.
Among 682 interventions, 452 were i.v treatments.Ten patients with a Karnofsky index
lower than 50 died after receiving an average of 19 home treatments.
Conclusions: I lHome care turns out to be rather effective if the request for treatment is
done at the initial stage of the disease and Karnofsky index is greater than 60.
Salotti Alessandra, Dept. Infectious and Tropical Diseases, La Sapienza University PoliclinicoUmberto I,Viale del Policlinico 155,00161 Rome, ItalyTel. 39 6 491749 Fax: [phone]
Tu.B.215 I
REASONS FOR PATIENT DECISIONS ON CLINICAL RESEARCH PARTICIPATION
Hawley Foss, Nanci, Cameron B. University of COttawa at the Ottawa General Hospital,
Ottawa, Ont, Canada
Issue: Pertsons with HIV decline or participate in clinical research for many reasons.We
sought to clarify the factors driving voluntarism in our clinical research centre.
Project: We performed a qualitative assessment of patient voluntarism and participation in
clinical research at the Ottawa General Hospital (OGH) HIV Clinic. Sixty patients have
been interviewed and completed a short structured questionnaire on their current and
past involvement with research in the clinic setting, on their attitudes towards future
involvement in clinical drug trials, pharmacokinetic and laboratory studies and with surveys
and questionnares.The patients so far interviewed represent an unselected 10% of our
active clinic population, which for I1995 followed 46 I persons regularly (>biannually) and
292 persons irregularly (<biannually) for a total of 753 active patients.
Results: Patient participation ever in research is extensive (89%) among those asked to participate. However; 25% of patients have ever chosen to decline participation in past or current research. In this survey's participants, the usual reasons for voluntarism were: I) to benefit others in Ithe future (94%), 2) to assist medical research (84%), 3) to benefit their own
personal health care (64%). Common statements among volunteers were "research provided hopefulness, '"a better understanding of their disease" and "an improvement in their
daily living." In non-participants who were asked and ever declined in the past, reasons
were: 1) too many mandatory clinic visits (50%), and 2) personal feelings about how overall
research is conducted (14%). Common statements among those who declined and who
expressed negative feelings towards clinical research were "research was personally stress
ful" and "participation caused feelings of uncertainty."
Lesson Learned: These negative perceptions did not alter a patient's willingness to be
Involved in other future research (86%). Loss of control may limit persons' willingness to
subject themselves to clinical research activities.This ongoing survey identifies that clinical
research participation in our clinic is high, driven first by altruism, second by desire for beneficial medical research and lastly by direct personal gain.
N. Hawley-Foss, Ottawa General Hospital, 501 Smyth Rd., Rm. G12 Ottawa, Ontario
Canada K II- 81L6 Tel: [phone] Fax: [phone]
Tu.B.2 152
FACTORS ASSOCIATED WITH USE OF ANTIRETROVIRALS AND PRIMARY
PROPHYLAXIS IN 3122 EUROPEAN HIV-INFECTED PATIENTS.
Lundgren, ens D.(*), Phillips AVella 5, Katlama C, Ledergerber B, Johnson A, Reiss R Gatel J,
Clumeck N, Dietrich M, Benfield T Nielsen (, Pedersen C, and the EuroSIDA study
group.esee below
Objective: To assess factors associated with use of antiretroviral (ARV) therapy and primary
prophylactic regimes to prevent HIVassociated opportunistic infections
Methods/patients: Baseline data from a prospective study on 31 22 consecutive, unselected
HIV infected patients with a CD4 count < 500 cells/ul followed at 37 clinical centres in 16

European countries in the summer of 1994. Europe was divided in to southern, central and
northern regions.The three regions had a similar proportion of patients with AIDS (32% of
total), but patients in northern Europe tended to have a lower median CD4 count than
patients from central and south Europe (175, 193 and 191 cells/ul, respectively p-0.02).

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