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

Tu.C.2689 - Tu.C.2694

Tuesday July 9, 1996

Tu.C.2689
THE ASSOCIATION OF STD WITH HIV TRANSMISSION FROM HIV POSITIVE MALE
BLOOD DONORS TO THEIR REGULAR FEMALE PARTNERS
Suriyanon,Vrnai*, VWanapirak C*, Srisomboon J*, Rungruengthanakit K*, Keawvichit R*,
Wongworapat K, Duerr A*, Nelson KE*0*. *Chiang Mai University, Chiang Mai,Thailand,
**CDC,. Atlarnta, GA, USA, * *The Johns Hopkins University, Baltimore MD USA
Objective: To evaluate the association of STD with HIV transmission from HIV infected
male blood donors to their regular female partners.
Methods: Regular fermale partners of HIV positive male blood donors at Chiang Mai
University Hospital in northern Thailand were interviewed and examined. Women with risk
factors for HIV other than sexual contact with the index male were excluded. Endocervical
cultures for gonorrhea, chlamydia and T. vaginrlis and serological testing for syphilis, HSV- I,
HSV2 and H. ducreyi were done on all eligible subjects; tests for H. ducreyi specific antibodies used the lipoolrgosaccharide menmbrane antigen (Alfa M.J. et al, Infect Dis
1993; 67:1206 1210) and for HSV- I and HSV-2 used immunoblot reaction to baculovirus
expressed glycoprotein GC (Sanchez-Martinez et al., Infect Dis 1991;164:11 96- 199).
Results: 497 women were studied; 232 (46.7%) were HIV positive. HIV positive women did
not differ from HIV negative women by demographic characteristics, mean age at first intercourse and frequency and type of sexual practice. HIV positive women were more likely to
have history of any STD (OR 2.0, 95% ClI 1.3-2.9), genital herpes (OR 3.0, 95% ClI 1.4-6.7),
swollen inguinal lymph nodes (OR 4.8 95%CI 1.2-2 1.5) during the previous 3 years and
positive serology for HSV 2 (OR 2.2, 95% CI 1.2-4. 1). Although HIV positive women were
more likely to be positive on serology for H. ducrey, this was not statistically significant. STD
history or diagnosis in the mnale index were not associated with HIV positivity in the
females.
Conclusion: HIV I prevalence among regular female partners of HIV positive male blood
donors in northern Thailand was high. It was associated with history and serologic diagnosis
of anr STD particularly genital herpes in the women but not in their male partners.These
data suggest that STD which are transmitted from HIV positive men to their wives may be
irportant cofiactors for HIV transmission in northern Thailand.
Vinai Suriyanon, MD, Faculty of Medicine, Chiang Mai University Chiang Mai 50200,Thailand.
Tel: [phone]. Fax [phone].
Tu.C.2690
KNOWLEDGE OF HYGIENIC PRACTICES OF HAITIAN WOMEN
Ascencio,Maxi*, Mellon, L.R.*, G61in-Charlot, C.*, Pape, J.W*1, Liaauud, B.*. *Les Centres
GHESKIO, Port-au-Prince, Haiti.I Cornell University Medical College, NY NY
Objectives: To determine the hygienic practices of Haitian women.
Material/Methods: A survey of hygienic practices in women seen at our institution by
administering a questionnaire to 600 women.
Preliminary Results: Of the 615 women surveyed, 21.8% women were HIV-seropositive
and 8.6% had a positive RPR. a) Everyday toilet: 82% of women practice internal (vaginal)
washing, 96% put their fingers into the vagina while washing, 35% add a product to water
used for internal washing, 8% use traditional leaves for regular washings, 39% of women use
a collective container, shared with other women, 10% use a vessel also use for urination at
the night, shared with others, 59% complain of vaginal discharge at the time of interview,
72% report vaginal discharge during the previous 3 months. b) During menses: 76% use
pieces of clothes for protection during menses, 17% are regular hygienic pads users, 88%
claimn they would use pads if they could afford the cost, 20% use only 2 pieces of clothes
during menses, 92% using clothes wash them only at the end of their menses. c) After
delivery: 55% use traditional leaves in the period following delivery 66% of women use
steam washing (including leaves in 60% of cases) in the period following delivery
Conclusion: For the first time, we have controlled data about hygienic practices of Haitian
women with poor income. Hygienic pads are not used by 88% of women, mainly because
of economical conditions. Hygienic practices differ notably with standards in developing
countries.The use of fngers, antiseptics or leaves into the vagina could potentially have an
impact on the vaginal flora and on the trophicity of vaginal and cervical mucosa and
become a potential cofactor for the transmission of HIV.
Bernard Liautaurt, Centres GHESKIO, Division International Medicine, Cornell University
Medical College A 431, 1300 York Avenue, New York, NY 10021 Telephone: [phone]
Tu.C.269 I
STABILITY OF HIV INFECTIVITY IN SEMINAL PLASMA AT 4~C
Rasheed Suraiya. Li Z., Xu D. Laboratory of Viral Oncology and AIDS Research, University
of Southern California, School of Medicine, USA
Objective: To compare HIV infectivity in seminal plasma vs blood plasma and to define in
vitro correlates (factors) that may influence HIV transrmission in vivo.
Method: Starting with >1000 cell culture infectious units (CCIU) in the first dilution, serial
5-ford dilutions of a clinical HIV- IJRCSF isolate were prepared separately in the seminal
plasma (1:2), and blood plasma from healthy HIV- seronegative individuals, according to the
techniques standardized in this laboratory (J. Rep. Med. 40; 747-757, 1995). Identical virus
dilutions in the cell culture medium were used as controls. A total of 31 2 aliquots of virus
dilutions were incubated for various time points at oC and then tested for infectivity in
vitro using peripheral blood mononuclear cells fhom HIV-seronegative donors. Presence of
viral RNA in the inoculum was confrmed at each time point using the reverse transcription
polymerase chain reaction (RT-PCR) technique.
Results: Our results indicated that HIV was well-protected in the seminal plasma at 4oC
and remained infectious for >4 weeks. After the initial reduction of virus titers in the first 7
days, no further decline of virus infectivity was noted in the seminal plasma (i.e. virus was
isolated in vitro). In contrast, virus infectivity declined significantly within I week in the blood
plasma at 4.C, and after 14 days, no virus was isolated from the highest concentration of
virus stock containing > 1000 CCIU. However there was no significant difference in the
level of viral RNA in the blood plasma or the seminal plasma after 4 weeks of incubation at
4"C.
Conclusions: We conclude that the rate of decline in the infectivity of HIV is greater in the
blood plasma than in the seminal plasma. Our data also suggest that normal seminal plasma

contains factors" that protect HIV integrity such that it remains infectious for extended
period of time (> 4 weeks) when stored at 4~C.
Suraiya Rasheed, Jniversity of Southern California, School of Medicine, I 840 N. Soto St.,
Room 103, Los Angeles, CA 90032, USA.Tel: (213) 227- I 840; Fax: (213) 227- I 840; email:
[email protected]
Tu.C.2692
ASSOCIATION BETWEEN PRESENCE OF VAGINAL LACTOBACILLI AND
ACQUISITION OF HIV AND STDS
Martin Harold Li, Nyange PM2O, Richardson BA I, Chohan B3, Hillier SL4, Mandaliya K3,
Achola JO,,Kreiss JKI. ( University of Washington, 2University of Nairobi, 3Coast Province
General Hospital, Mombasa, Kenya, 4University of Pittsburgh, *deceased)
Objectives:To prospectively evaluate the relationship between vaginal lactobacilli and the
acquisition of HIV and STDs.
Methods: HIV seronegative female sex workers attending a research clinic in Mombasa,
Kenya underwent monthly HIV and STD screening.Vaginal swabs were inoculated onto
Ragosa agar and cultured for the presence of lactobacilli.The correlation between the presence of lactobacilli and HIV and other STD pathogens was examined using generalized estimating equations.
Results: Lactobacilli were isolated from 22% (628/2883) of vaginal cultures from 440
women followed prospectively Hydrogen peroxide was produced by 43% of isolates.The
presence of lactobacilli was inversely associated with bacterial vaginosis (BV). whether
assessed by gram stain (OR 0.5, 95% CI 0.4-0.7) or detection of clue cells on wet prep (OR
0.7, 95% CI 0.6- I.0).The presence of vaginal lactobacilli was inversely associated with gonorrhea (OR 0.7, 95% CI 0.4- 1.0, p=0.05).There was a trend for an inverse association
between vaginal lactobacilli and HIV seroconversion.The odds of acquiring HIV antibodies
while vaginal lactobacilli were present was 0.5 (95% Cl 0.2-1.3, p=0. I1).There was no significant association between the presence of vaginal lactobacili and chlamydia, trnchomonas,
genital ulcer disease, or vulvitis.
Conclusions:The presence of vaginal lactobacilli by culture was inversely associated with
bacterial vaginosis and gonorrhea.There was a trend for an inverse association between
vaginal lactobacill and HIV seroconversion.These results suggest that vaginal lactobacilli may
protect women f om acquisition of certain STDs.
Harold L. Martin, Jr:, MD MPH Harborview Medical Center, 325 Ninth Avenue, Box 359909,
Seattle WA 98104 2499, USA Tel: [phone], Fax: [phone], email: hal@(u.washington.edu
Tu.C.2693
HIGH RISK BEHAVIORS IN HIV-INFECTED PERSONS
Buskin Susana,*** Thiede H*, Hopkins S*** *Seattle-King County Department of Public
Health, Seattle, W/A,USA; ** University of Washington, Department of Epidemriology, Seattle,
VVA, USA
Objectives: To characterize persons living with HIV and receiving medical care whom are at
increased risk of transmitting HIV to aid the planning of targeted, effective HIV prevention
programs.
Methods: The Seattle Spectrum of HIV-related Diseases Study conducts medical record
abstractions for a I year baseline period and every 6 months thereafter at 9 outpatient
clinics. Men of color and women are oversampled. From 1/29/90 to I12/31/95, 276 women
and 2394 men were followed an average of 2.4 years. High risk behavior was defined as:
new onset sexually transmitted diseases (or STDs, including gonorrhea, early syphilis, hepatitis B, and chlamydia). unsafe sex, exchange of money or drugs for sex, and/or needle sharing
as documented in the medical record.
Results: Overall, 19% of the cohort had high risk behaviors, including 8% with acute STDs.
The following were significantly associated with high risk behaviors after adjustment by logistic regression for each of the other factors, depression, alcohol use, length of follow-up, and
number of outpatient visits: female gender odds ratio (OR) = 5.7 (95% confidence interval
- 3.4 - 9.6); less advanced disease (asymptomatic & CD4>499 cells/pL vs. clinical AIDS &
CD4 < 200) OR = 3.9 (2.5 - 6.0); men who had sex with men vs. heterosexuals OR = 2.2
(1.2-4.0); younge age (<30 years vs. 50+) OR = 2.0 (1.1 - 3.8); non-injection drug use OR
= 1.5 (I. I - 1.9); and non-white race/ethnicity OR = 1.3 (1.0 - 1.7). In a comparable logistic
regression model with STDs alone as the outcome, statistically significant associations were
found for female gender OR = 3.4 (I.7-6.5) and less advanced disease OR = 2. I (I.2 -
3.9).
Conclusions: Observed gender differences might be attributed to lower levels of STD
screening and ascertainment of risk behaviors in men, making comparisons complex.
Although many important factors are not feasible to collect through medical record review
(e.g. HIV serostatus, sexual behaviors, and informed consent of partners), it was possible to
identify subsets of HIV infected persons who were more likely to engage in high risk behaviors, endangering their own health and potentially that of others.
Susan E Buskin 400Yesler Way 3rd Floor: SeattleWA 98104 USA
Tel: [phone]fl45 Fax: [phone]: e-mail: [email protected]. edu
Tu.C.2694
ORAL/GENITAL CONTACT AS AN INCREASING MEANS OF HIV ACQUISITION
AMONG MEN WHO HAVE SEX WITH MEN.
SchackerIT., Collier A., Shea T. Corey L. University of Washington, Seattle, WA.
Objective: To investigate transmission patterns associated with the acquisition of HIV infectio~n.
Methods: Persons with serologic evidence of acute and very recent HIV seroconversion
were enrolled. A standardized questionnaire collecting informaton on recent sexual contacts and sexual habits was administered.
Results: Forty three men were identified within 47 days of laboratory confirmed HIV seroconversion. Forty-two of the 43 men reported sexual contact with other men as the only
risk behavior for HIV acquisition. Overall, the median number of reported sexual partners
in the 6 and I months prior to seroconversion was 3 and I respectively; only I 2% reported more than 5 partners in the month prior to acquisition. In the 6 months prior to acqusi-ion, unprotected oral/genital contact was the most frequent reported sexual activity: the

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