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

Tu.C.2388 -Tu.C.2392

Tuesday July 9, 1996

Objective: We measured several kinetic processes in men with AWS and nOrial controls,
using stable isotope/mass spectrometric techniques.
Methods: Processes included lipolysis, hepatic de novo lipogenesis (DNL) and cholesterol
(C) synthesis; hepatic glucose production, pathways of glycogen synthesis, and gluconeogenesis (GNG), by dilution or mass isotopomer methods. Kinetic processes were compared to
soluble TNF receptor I and II, IGF- I, triglycerides and lean body mass (LBM) response to
nutritional supplementation.
Results: Compared to HIV negative controls (Ctrls), abnormalities of mean values in AWS
were observed for lipolysis (n -= 18) (25% elevated), resting energy expenditure (n - 15)
(I 3% increased), substrate cycling (n = 15) (elevated, but thermogenically insignificant at
<20kCal/day); DNL (n = 73) (markedly increased, especially in fed state, but highly variable
among subjects and not accounting for body composition differences quantitively); C synthesis ( = 25) (increased, despite low serum C, indicating increased losses not reduced
synthesis); glucose production (n = 28) (slightly increased in a subset but normally suppressable by iv glucose); direct glycogen synthesis pathway (n = 12) (reduced rather than
increased, excluding surplus hepatic glucose balance is not as explanation for increased
DNL); GNG (n = 17) (increased in subset, perhaps representing a nitrogen-depleting
process). Increased DNL or other kinetic abnormalities did not correlate with TNF RI or II,
TNF levels, IGF-I, C synthesis, Peripheral blood mononuclear cell cytokine release, triglyceride or cholesterol concentrations. Increased DNL was the most useful metabolic parameter for prediction of LBM response to nutrients (higher DNL, worse LBM response, r -
0.46).
Conclusions: We conclude that, (I) The pattern of lipid and CHO abnormalities is most
consistent with cytokine effects rather than dietary effects (more increased DNL in fed
state than fasted, as observed forTNF and glycogen stores in animals; increased C synthesis,
GNG, lipolysis; reduced direct pathway); (2) Circulating cytokines are not useful measurements; (3) DNL is a useful prognostic measure, presumably by reflecting cytokine presence;
(4) These metabolic changes do not explain altered body composition or energy expenditure quantitatively but by reflecting underlying metabolic abnormality; (5) Marked inter-individual variability may reflect pathogenic heterogeneity for AWS and prove useful in patient
stratification.
Marc K. Hellerstein, MD, PhD, Dept of Nutritional Sciences, 119 Morgan Hall, University of
California, Berkeley, CA 94720-3104. Tel. [phone]; Fax [phone]; email:
[email protected]
Tu.C.2388
CULTURES OF SEXUAL EXPERIMENTATION IN RELATION TO HIV
SEROCONVERSION
Ki pax Susan/, Culpin, A, Campbell, D, Prestage, G 1.2 1 Macquarie University Sydney
Australia; 2The University of New South Wales, Sydney, Australia
Objective: This paper explores risk factors for HIV among homosexually-active men living in
Sydney, Australia. It focuses in particular on social and contextual determinants of seroconversion.The data are drawn from an ongoing longitudinal cohort study Sydney Men and
Sexual Health (SMASH).
Methods: The SMASH cohort is a non clinical volunteer sample of over I, 100 homosexually active men. Men, recruited from gay community AIDS organisations, gay bars and saunas,
and word of mouth, participated in a six-monthly or annual behavioural survey and a clinical
assessment.The men were interviewed with regard to: sexual practice; sexual relationships;
attachment and engagement in gay community life; adoption of HIV avoidance strategies;
degree of contact with the AIDS epidemic; and knowledge of HIV transmission. By
December 1995, twelve men had seroconverted while under study.
Results: The sexual practice and social characteristics of these 1 2 men prior to their seroconversion were compared with the practice and social characteristics of 297 men -om
the same cohort who had remained seronegative during the same time period.The following were the most important determinants for seroconversion: having a known HIV positive
male regular partner; greater engagement in the social and political life of gay community;
and engaging in a wide range of sexual practices (with both regular and casual partners),
including esoteric sexual practices. None of the demographic characteristics distinguished
those who later seroconverted from those who remained seronegative. A logistic regression indicated that engaging in a range of esoteric sexual practices and having a known HIV
seropositive partner were the strongest predictors of seroconversion.
Conclusion: Initiates of cultures of sexual experimentation are at high risk of HIV infection
in this cohort of Sydney men.
Susan Kippax, NCHSR, Macquarie University, Sydney, NSW 2109, Australia Tel: [phone] Fax: [phone] Email: [email protected]
Tu.C.2389
FEASIBILITY OF A COHORT OF MEN WHO HAVE SEX WITH MEN (MSM) FOR
FUTURE VACCINE EFFICACY TRIALS:THE BELAVISTA COHORT STUDY, SAO
PAULO, BRAZIL
Carvalheiro,.R.*, Spink, M.J.P*,Veras, M.A.S.M.*. *Institute of Health; * Pontificial Catholic
University of Sfo Paulo; SR Brazil
Objectives: Immediate - to determine the incidence of HIV infection and its socio-behavioral correlates in an open cohort of MSM. Long term - to demonstrate the feasibility of
vaccine efficacy trials in Sto Paulo, Brazil.
Methods: The Bela Vista Cohort Study is a three year follow up of MSM who meet the following criteria: I) aged between I 8 and 59; 2) non users of intravenous drugs in the past 6
months; 3) negative on HIV tests. Recruitment sources include anonymous HIV testing centers, distribution of publicity material in places where MSM meet, use of media and snow
bali.Volunteers undergo an initial interview in which the objectives and procedures are discussed. If they decide to participate they sign the Informed Consent Form. Data collection -
which is repeated every 6 months - includes: collecting blood samples for HIV, syphilis, and
hepatitis B and C serology clinical evaluation and a comprehensive socio-behavioral interview
Results: 288 volunteers were recruited in the first 16 months since the beginning of this
study (in Aug., 1994), 25(8.7%) of which were excluded because of positive HIV serologies
on the initial test, and I 2 (4.2%).for non completion of the first stage of data collection.
Recruitment has varied between 6 and 40 volunteers/month (rnean--18). Anonymous

testing centers, t,e ilrni sources of recruitmen t initially, but was.soonr slirlanted y
snow ball. 91% ro rte, ra ng had sexual intercourse only with rne in the last six
months; 46% repo,, t, r -ected anal sex in the six months preceding the first interview;
40% reported c.ais t- rrapitted diseases (STD) before entering this study an d 8.6%
showed evidne -f 5T, t ihe first clinical evaluation.the present analysis included 251
volunteers who h d a c to i;., ilned the cohort. Ihere was one seroconve rsion and seven
losses of criteria volu tc r i follnow up. 1The reumairing 243 volurteers continued in obser
vation, at the first (I 30), s necond (8 1) anad third (32) six onth Iollow, up intervals.
Conclusions I) It is surpnsing the risk factors which are pr esent, specially the evidence on
STD)s and unprotected sex; 2) In spite of the low seroconversion rate so fai.,volunteer
have been recruited frtom a high HIV setopr evalence rate g roup. (considering the ia.onve and
3) Adherence to the cohoi t and the incr easing experience of the research tea ilea d o
the conclusion that future vaccine efficacy trials ii Saio Paulo, Brazil, are feasible.
(Supported by WHO, MS/BR, SES SP and FAPESP)
J. R. Carvalheiro, Rua Santo Aintonio, 5)90, 5" andar; 013. I1 000, Sao Parlo, SP Brazil
Telephone: [phone]; Fax: 00 55 II -6052772
Tu.C.2390
DETERMINANTS OF HIV INFECTION AMONG HOMO/BISEXUAL MEN IN BELO
HORIZONTE, BRAZIL:A NESTED CASE-CONTROL STUDY
Antunes, Carlos MF, Carneiro M, Camara G, Oliveira El, Greco DB. Mina s Gerais AIDS
Vaccine Cente,, Federa! tnivesit of rMinas Gerais, Brazil
Objective:To identify risk factors associated with HIV infection anong Iorno/bisexual men,
using a nested case-control design, within (a) an ongoig open cohort of Itf\l egative, ol
unteers and (b) a group of patients fio a SexuallyTransmitted Dise ases (Srt) CInc.
Methods: Among those volunteers bering interviewed and HIV tested for participation n a
cohort study (Project Horizonr, Belo Horizonte, Brazil), those testuing post ve (I 2). were
matched, by test date, to three controls eaach.The sare procedue ni s used to identif
cases (I12) and controls among patients who attended the I Iriae sity STD Clini c.1aia w as
collected by interview (age, income, race, education, civil status, sexual practices, alcohl ai r
drug abuse), carried out before the HIV test result was known. The analysis comipaed a)
cohort volunteers and STD Clinic patients (independent groups) and (b) cases (HI/V+) and
controls (HIV-), within each setting (matched groups); multiple logistic regression, unconditional and conditional methods, was used in data analysis.
Results: Cohort volunteer s differed from STD Clinic patients regardirng (a) inciae (7.2
4.6 Brazilian minimum wage, riespectively); (b) race (cohort, higher propor I on of white vs
non-white); (c) being paid for sex (higher pi oportion among STD patients) and (d) unpio
tected sex (higher proportion among STFD patients) Comnparing cases and conti rols regard
ing risk behavior among the cohort participants, unproteteed sex in the last six iiIs Iwas
the only significant difference after multiple adjustments; no differences were detected coi
paring cases and controls from the STID Clic.
Conclusions: Cohort participants, when compared to STD alinic patients in Belo
Horizonte, Brazil, were fiom a higher social class (income and r(e) and repo-ted less sexui
al risk behavior (paid and unprotected sex). Amiong t whse who volunteer for par ticipatior
in an HIV negative cohort, unprotected sex in the last six months was the main deterninant of their HIV infection.
Car os M F Antunes, Caixa Postal -86, 31270 901 Belo I-Iorizonto MG Brasil-tel: 55,-4
9773 Fax: 55-3 I-441 -9773 erail:antunesai 2.coni.br
Tu.C.239 I
DISCUSSION GROUPS ON MALE SEXUALITY AMONG BISEXUAL MEN TO
PROMOTE THE PERCEPTION OF VULNERABILITY TO HIV/AIDS
Seffner, F Support Group For AIDS Prevention (GAPA/RS), Por to Alere, B azil
Issue: An epidemiologcal analysis of AIDS in Brazil indicates a clea comporentf o birxal
relationships in men's sexual practices. Bisexuality is rnuch more comrmon than t,as
believed and it cannot be confused with homosexuality. SThe stignataotic of bisexial rnen
makes them vulnerable to H IVAIDS infection, and these men often infect the wives. So
far, there are no specific campaigns for this population in Brazil.
Project: Behavioral investigation amrong bisexual men iing in Porto Alegre, Brazil, aimed at
identifying, describing and analyzing hcss subjects perceivet-IlV/AIDS ailner ability, in o ider
to create effective comnrursic ato instruments for preventi ng contanination.The methodol
ogy combines interventions and data collection thiouh safer- sex roups and workshorps.
Results: After I 2 months, 5 groups have been put together for di scussion of male sexualit
and male bisexual behavior; involving 60 men from different cultural and economi srrla.
Twelve safer sex workshops have been done with mien and 3 ithtl women. fhe ideas pro
duced by the groups are subsidizing projects for AIDS prevention campaigns amr gbisexu
al men.
Lessons learned: The discussion groups on male sexuality have proved to be an importart
instrument to consolidate behavioral changes towards contamination by I lV/AIDS. By
working with the male population, we are having a very concrete impact on women, once
sexuality is built as a relational history between men and woen.
F Seffner, Av. Jofo Pessoa, 1065 ap. 315 CEP 90010.000 Porto Alese, Br azl Telephone: (55)
(05 ) 227.1705, email: seffnerfavortex.ulrgshr
Tu.C.2392
SEXUAL PRATICES WITH RISK OF HIV INFECTION AMONG GAY MEN IN THE
SECOND BIGGEST CITY IN NORTHEASTERN BRAZIL
Gondim, Rogerio C, Kerr Pontes *, MartinsTn*- Mota R" Gript de Apolo i
Prevencf.o a AIDS (GAPA-CE), Cears, Brazil n-tUniversidade Foleral d e car caa Br ril
**Secretaria de Estado da Saude (SESA CE), Ceara, Brazil
Objective: To anlyze the association between sexual piatices and the nsk It infection 'i
HIV among men who have sex with other me (MSM) ad social aiI-. a I ir al a
Methods: A semi structured questiornnaire was applied to 50 I MSM wit t rs a.,
technique in the city of Fortaleza, the second biggest capital in norah-ater B azal.AnI
was made with SPSS-PC software, and slatistcal tests to contilgece tIable weicr plid.
The interviewed wean reeruited in a wa to guararie a ria ala i, air-i f i, I r(i
social class (A upper B miIddl C-ow ) il i ag rse range (up to 2) y a ) i-i rear
22 and 32;bet-ieens 32 arid 52,;i as oer 12).

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