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

Monday, July 8, 1996

Mo.B.434 - Mo.B.541

Mo.B.434
RISK FACTORS IN MOTHERS OF CHILDREN WITH KAPOSI'S SARCOMA (KS):
A CASE CONTROL STUDY.
Mwidu S, 7_ iegler IL, Katongole Mbidde E, Tindyebwa D, Marum L, Newton R, Beral V. Parkin
DM, DeCock KM. Jaffe H,Weiss R the Uganda Kaposi Sarcoma Study Group. Makerere
University Kampala, Uganda
Objective: To determine the risk factors for childhood KS and to assess whether KSHV
(HHV 8), the putative aetiological agent of KS, is transmissible from mother to child.
Methods: Since January 1995, newly diagnosed children with KS (cases) have been registered and their mothers interviewed. For every case 3 children with other cancers and 3
children with HIV/AIDS and their mothers are similarly enrolled as controls. All consenting
subiects ae counselled and tested for HIV KS and cancer tissue, sera and buffy coats (for
leukocyte DNA) from mother child pairs are stored for KSHV (HHV-8) testing.
Results: Children with KS have a prevalence of HIV infection of 58.4% (21/36 tested) versus 12.7% (13/ 103 tested) in cancer controls (O.R.= 9.69, C.I.= 3.7-25.9).Thus far 128
nmothers have been enrolled: 24t children have KS, 77 other cancers, and 27 HIV / AIDS
without KS. The prevalence of HIV infection in mothers of HIV positive and HIV negative KS
children is 95 and 30% respectively In addition to an increase in HIV positive KS cases, the
number of HIV negative KS children has increased, approximately 9 times higher than,
reported in the pre-o HIV era. Compared with controls, KS children or their mothers do not
differ signit anty with respect to obstetric or sexual behaviour history
Conclusion: Other than HIV infection, there are as yet no signifcant differences between
mothers of KS children and control mothers. KS diagnoses have apparently increased in HIV
positive as well as HIV negative children in Karmpala. Analysis of KSHV (HHV8) in motherchild pairs is underway
Ms. L.K. Francis,The Centre, I4 Harvey Brown Avenue, Milton Park, Harare, Zimbabwe.
Tel/Fax: [phone]
Mo.B.435
CURATIVE THERAPY FOR AIDS CANCERS
Miles Steven A. UCLIA Care Center, Los Angeles, CA 90095
Many AIDS clinicians view patients with AIDS-related malignancies as uncurable. Recent
laboratory and clinical data suggest that successful treatment may already be here for may
of these patients, For example, the recent identification of the Kaposi's sarcoma herpes
virus (HI-HV8) and partial genomric cloning have provided a wealth of new therapeutic
opportuntities. Preliminary reports of new serologic assays, the efficacy of antiviral compounds, and in improved understanding of the relationship of KSHV and cytokine disturbances provide multiple interventional points. Therapy for Kaposi's sarcoma will be radically
different in the next two years.
Similarly over 50% of patients with AIDS-related lymphomna can be cured with conventional
chemotherapy new, potentially curative drug regimes including infusional CDE, 9-amino
camptothecin, MGBG and other novel agents provide hope for the remaining patients.
Physicians should approach patients with AIDS-related malignancies as having a potentially
curable and eventually preventable disease.
SA Miles, BH- 412 CJS. 10833 0eConte Ave, Los Angeles, CA, 90025 USA
Tel: [phone] Fax: [phone] I
Mo.B.531
A RATIONAL APPROACH TO THE USE OF ANTIRETROVIRAL AGENTS
VellaStefano, Floriadia M. Laboratory of Virology, Istituto Superiore di Sanita, Rome, Italy
The number of antiretroviral drugs available for treatment is currently high enough to allow a
considerable variety of strategies (e.g. early versus late), of combinations and of sequential
regimens, which can also be better tailored to the medical status and preferences of the individual patient. In the design of first- line antiretroviral therapy highly effective regimens can
now be selected on the basis of the virological efficacy defined by phase II studies, anrd rationale combinations can be designed considering resistance profiles, cell and tissue activity and
toxicity patterns. Although the bulk of knowledge recently accumulated on HIV pathogenesis
suggests early aggressive therapy this approach must be weighted against the number of
available antiretroviral drugs for stubsequent treatment. In this perspective, the design of antiretroviral treatment for the individual patient should not be limited to first-line treatment,
and great care should be taken to identify subsequent paths" which can ensure, through a
rationale sequencing of treatments, the most prolonged efficacy of antiretroviral treatment.
Different strategies (e.g. using immediately the most potent drugs or saving the most potent
regimens for the later course of infection) or different sequences of drug combinations
could lead to similar outcomes. It is most likely that this process will be driven by viral load
measurements, which can surely represent a more precise marker than CD4 for identifying
the more appropriate moment not only for starting, but also for changing treatment. The
increased availability of drugs and the advances in pathogenesis are now strong arguments
to recommend a change of treatment at the first evidence of loss of antiviral activity preventing lthe development f overt drug filure, which is associated to some virological
isf neave pronostic ining. An ircreased number of options remain open for
changing trsatmert durin t the course of the infection; in this perspective, all the drugs with
a suffcient degree of antiviral activity can have a place, even if their effect is of short duration; their use, however; should be rationalised through the design of some pathways which
allow to gain the higher beneft from all the available antiretroviral drugs.
S Vella,Viae Regina Elena 299, 001i6I Rome, Italy Tel: [phone] Fax: [phone]
E ail: vel vi i u s I.rss.errfn.ii

Mo.B.533
FORMULATING RATIONAL USE OF ANTI-RETROVIRALS IN THAILAND
Nicholas Prescott(2), Chaios Kunanusont(I ),Wiput Phoolcharoen(I ),Wiwat
Rojanapitayakorn(I ), Joseph Perriens, Damrong Boonyuen(I). (I )Dept of CDC, Min of
Publ Health,Thailand; (2)World Bank, (3)World ealth Organization
Background: An evaluation of antiretroviral policy options was conducted in 1995 3 years
after initiation of government-subsidised Zidovudine (ZDV) in Thailand. Experts from the
World Bank, the World Health Organization,Thai universities, and the Thai Ministry of Public
Health formed joint working groups on epidemiologic projections, policy alternatives, clinical
efficacy and economic analysis.
Findings: First, the subsidy for antiretroviral treatment of adults would be unaffordable compared to the National AIDS budget (US$ 60 million in 1996).The affordability ratio of
subsidy to budget ranged from 235% in ZDV monotherapy for adult AIDS to 620% in
combination therapy However a ZDV/formula feeding regime to reduce mother-to-infant
transmission would have an affordability ratio of I 6%. Second, antiretrovirals for perinatal
intervention would be more cost-effective than for treatment of adults. Cost-effectiveness
ratios ranged from 2,300 baht per Quality-Adjusted Life Year (QALY) for prophylaxis of
pediatric HIV to 85,000 baht per QAILY under combination therapy for adult AIDS.
Conclusion: Anti-retroviral therapy for adults is both less affordable and less cost-effective
than antiretroviral prophylaxis among infected pregnant women. Further studies of actual
coverage and provider/patient compliance were suggested.The Ministry of Public Health
needs to consider reallocating resources for antiretrovirals and gradually adjust its policy so
as to achieve greater efficiency in meeting the needs ofThai society as a whole.
Chaiyos Kunanusont, AIDS Division, Dept of CDC, Ministry of Public Health, Nonthaburi
II 000, Thailand. e'mail:chaiyos(health.moph.go.th
Mo.B.540
MENSTRUAL ABNORMALITIES IN WOMEN WITH HIV INFECTION
Cohen, Mardge H, Greenblatt R, Minkoff H, Barkan 5, Burns D, Denenberg R,Young M.
Levine A for the WIHS Collaborative Study Group.
Objective: To determine the prevalence and etiology of amenorrhea and to describe menstrual abnormalities in women with HIIV infection.
Methods: The Women's Interagency HIV Study (WIHS) is a multi-site cohort study of HIVinfected women and a comparable at risk uninfected control group. Data for this analysis
was available on 1416 women. Women were excluded if they were pregnant, lactating, or
self reported being post-menopausal, having had a hysterectomy or bilateral oophorectomy
We included 1,002 women (797 HIV infected, 205 HIV uninfected) in the analysis for
amenorrhea (defined as no menses within the past 90 days). For menstruating women,
questions regarding menstrual abnormalities were analyzed by serostatus.
Results: Prevalence of amenorrhea was 5.5% in HIV-infected women and 3.9% in the HIVseronegative group. Amenorrhea rates increased to I 2.3% in HIV infected women with
CD4 count<50. Current heroin use, recent injection drug use, increased alcohol consumption, and albumin less than 3 were significantly associated with amenorrhea. Hormone analyses including LH/FSH and estradiol will be presented for amenorrhea etiology determination. Menstrual cycle abnormalities reported within the past 6 months included: prolonged
average menses >7 days (36%), irregular menses (62.6%), skipped menses (I 5.7%), spotting
or bleeding between menses (I 5.4%), and post coital bleeding (6.5%).These rates were
comparable in HIV infected and at risk HIV negative women.
Conclusion: Although the prevalence of amenorrhea was comparable among HIV-infected
and uninfected women, women with very low CD4 cell counts reported the condition significantly more frequently than others. Menstrual abnormalities are common and occur at
similar rates in HIV infected and at risk HIV negative women.These findings suggest that
HIV-related disease progression influences the occurrence of menstrual cycle abnormalities,
though HIV infection itself does not.
Mardge H. Cohen, M.D., 1835 West Harrison, Chicago, II 60612 USA Tel:[phone]:
Fax: [phone]; E-mail: [email protected]
Mo.B.541
REDUCED FERTILITY AMONG HIV-INFECTED WOMEN. RESULTS OF
CROSS-SECTIONAL AND PROSPECTIVE STUDIES IN RURAL UGANDA.
Gray Ronald H*, Wawer M.J**, Wabwire-Mangen F***, Sewenkambo N***, Serwadda
D***, Kigonzi G***, Paxton L**, Li C*,Yan Y', McNairn D*, Kiwanuka N***.
Johns Hopkins University Baltimore, USA, Columbia University, New York, Makerere
University Kampala, Uganda.
Objectives: To assess the association between HIV infection, STDs and fertility in two studies from rural Uganda.
Methods: Data were derived from two studies in Rakai District, southwestern Uganda.
These were: I) a cohort study of 3,502 women followed between 1990-93 with annual
interview information on pregnancy and births; and 2) a study of 5,236 sexually active
women enrolled during 1994-95 into an ongoing community-based clinical trial. In the latter
study pregnancy status was determined by interview and by urinary hCG tests. Laboratory
samples were collected for other STDs including syphilis and chancroid serology chlamydia
and gonorrhea (urinary ligase chain reaction), and trichomonas cultures/BV gram stain from
self-administered vaginal swabs.

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