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

Mo.B.l 175 - Mo.B.1 180

Monday, July 8, 1996

Results: 211 (94.6%) patients received a mean of 5.3 (S.D.3.84) prescription medicat ions
during consecutive 90 day period.The mean cost of medication was $1,237.62 per patient
(S.D. 175 1.49). Patients with AIDS diagnosis received a greater number of medication; an i
average of 6.6 1 versus HIV patients who received 3.43 and 3.48 among a<rymptomatic
patients. Therapy with zidovudine $61 1.8 I and stavudine $596.96 had the highest costs.
Utiization and costs of other commonly used medications in the manager ert Iof HIV
infected persons are also described.
Conclusion:Fhe study show th e cost of drug treatment for HIV-infected patent has
remained stable since early 1990'. However, the ever changing dynamic of this disease will
continue to make predictions weak and comparisons difficult.
EFernandez, HRSA/BHPr, 5600 Fishers Lane, Rockville, MD20857, Telephone: [phone]
FAX [phone] Email: [email protected]
Mo.B.1 175
DIAGNOSIS OF HIV-I INFECTION IN CHILDREN BORN TO HIV-I INFECTED
MOTHERS.
Liberatore Diana, Avila M. M., Martinez Peralta L., Libonatti O. Department of lMicrobiology,
School of Medicine, National Reference Centre for AIDS, Buenos Aires, Argentina.
Objectives: Laboratory diagnosis of HIV infection in pediatric patients represents a major
challenge because of transplacentary transmission of maternal antibodies.The aim of this
work was to develop a test for early diagnosis of HIV I in children by detection of specific
IgA antibodies.
Methods We have evaluated the clinical utility of detecting anti-HIV IgA antibodies in children's sera after removal of IgG with recombinant protein G.A commercial EIA kit for HIV
I IgG detection was used, determining IgA presence by the use of an anti IgA conjugate.
Results:A total of 88 serum samples from 73 children were tested.Thirty seven of these
were classified as HIV infected (CDC, 1994) and 36 resulted non infected. Out of the 50
samples from infected children, 4 1 were positive and 9 were negative as shown below:

Age (months
<5
6-12
TODAL

IgA Pos
3
38
41

IgA Neg
6
3
9

Highest sensitivity was observed in children over 6 months.The 38 samples from uninfected
children resulted always negative.When IgA detection was compared in tandem with p24.antigen detect on, isolation of virus by coculture and with PCR, IgA detection re sulted the
most sensitive (2:1 for antigen detection, 3:1 for PCR and 2.4:1 for viral isolation).
Neverthele ss, it is important to stres that in most of these children these tests resulted
positve n some of the tested samples.
Conclusions: IgA detection demonstrated high sensitivity and specificity, being a cheap, simple and reliable test thrt could be applied in hospital laboratories in developin countries.
LIBERATORE Diana. Paraguay 2 155 piso I I. 1 121 Buenos Aires, Argentina.
Phone: 54-I 961 -8124 Fax: [phone]
Mo.B.1 176
A NEW GENERATION OF HIV-DIAGNOSTIC ASSAY:TESTING FOR ANTI-HIV AND
HIVAG IN ONE DETERMINATION
Faatz, E*, Ujameier B*, Hoss, E*, Louwagie.J,,Ofenloch, B*. *Boehringer Mannheim,
Germany; Innogenetics, Belgium.
Introduction: Even with the best anti-HIV diagnostic assays the early detection of seroconversion is on the average 5 to 7 days later than the detection by HIVAg-assays. Since per
forming HIV screening with HIVAg assays in addition to anti-HIV assays is very expensive,
we tried to combine both types of assay in one determination in order to shorten the
diagnostic window phase at reasonable costs.
Results: To be able to detect anti-HIV-antibodies and HIV p24 antigen in one reaction, the
antibody detection has to be performed with the glycoprotein epitopes but without p24
antigen.Then a simultaneous detection of HIV p24 antigen can be done with p24 monoclonal antibodies.
By using Biotin-labelled antigens and p24 MAbs and a Streptavidin sohd phase, as well as
Digoxigenin-labelled antigens and p24 MAbs and an anti-Digoxigenin peroxidase conjugate,
we could establish an anti-HIV/HIVp24rg-combined assay.
This assay s nearly as early in the detecti on of seroconversion as a HIVAg assay but detects
anti-HIV antibodies as good as a 3rd-generation anti-HIV assay with a specificity of > 99.5%.
Dr.Elke Faatz, Boehringer Mannheim GmbH, Nonnenwald 2,82377 Penzberg, FRG.
Tel: [phone], Fax: [phone].
Mo.B.I 177
CHARACTERISTICS OF A STABILIZATION ASSAY TO DETECT SPECIFIC ANTIBODIES TO REVERSE TRANSCRIPTASE OF HIV
Morita, Minoru,*,Yoshida H*, Suzuki T*, Hoshino H.**. 0The Kitasato Institute, Tokyo, Japan;
**Gunma University School of Medicine, Gunma, Japan
Objective: We developed a stabilization assay to detect antibodies against reverse transcriptase (RT) of HIIV I. We examine the specificity and clinical significance of this assayThe
specificities of stabilization and neutralization assays against RTs of HIV 1, HIV2 and SIV are
examined comparatively
Methods: Human sera were obtained from subjects negative or positive for anti-HIV I or
HIV 2 antibody SIV antibody positive sera were derived from infected monkeys. Stabilization
assays were done as follows: sera (2pl) were mixed with virus lysate (20pl) and incubated
at 37"C I Omirn and then at 56"C 20min. Neutralization assays for RTs were done as follows: sera (2pl) were mixed with virus lysate (20pl) and incubated at 37~C for 30min.Then
residual RT activities were determined
Results: HIV I antibody positive sera stabilized HIV I RT but not HIV-2 RT, whereas half of
these sera cross-neutralized HIV-2 RT Antibody titers against RT determined by the neutralization assay and stabilization assay were compared with clinical characteristics: Results of
the stabilization assay significantly corrected with CD4 numbers and CD)4/CD8 ratios of
patients. Antibodies against HIV- I RT were much more frequently detected by the stabilization assay than by the neutralization assay RTs of HIV I, HIV-2 and SIV were distinguished

by the stabilzaton as y using sera positive for HIV- I, HIV2 or SIV antibedy although RTs
of HIV2 and SYIV 'AC r-oss- reacted even by the stablization assay
Conclusions: The sti-Izn assay is a new method to deect specfi antibodies a gainst RTs
of HIV I, HIV 2 and SVThese was significant correlation between st brhzinir anrtibody titers,nd clinical di If f c'r!
phis work wra drn e r ) oration with K. Nakajirma, C. Shiozawar, M J. Gill snd M. HIyrni.
Minoru Mon itaaTheF t r i Institute, Shi okane, Minato ku, Tokyo 108, Japan. Telephone:
(81) -3-344t 6161 F,x: 81 1) 344 t4298
Mo.B.1 178
FALSE POSITIVE RATES OF ANTI-HIV ANTIBODY TESTS, EIA AND PA
Osato, Kazuhisa, MatsubayashiT, NagaoT Inuzumi K, Araki H, Kawa K Osaka Prefectural
Bandai Clinic for STD, COsaka, Japan
Objective: To investigate the false positive rates of anti-HIV antibody tests, EIA and PA.
Methods: Enzyme linked rimmuno-sorbent assay (EIA) and particle agglutination (PA) were
used for screening tests of anti-HIV antibodies Ind WB was used for comfirmatory test.
Results: Eleven false positive cases were found in 4687 samples tested with ElA.The false
positive rate of EIA was 0.2 347% ( I 1/4687). Six were found to be false positive in 34041
samples tested with PA and the false positive rate of PA was 0.0176% (6/34041). On the
other hand, the true anti-HIV antibody positive cases were 4 out of 42452 overall screerning
tests and the positive rate was 0.0094% (4/42452).
Conclusions: The false positivity of EIA anti-HIV antibody test evaluated recently by another
Japanese HIV research group was 0.224 1% (50/22310), which is very close to our rate of
0.2347%.Thus, the false positive rate of EIA is rmore than ten times higher than that of PA,
whose false positive rate itself is almost two timres higher than that of the true sereo positivi
ty of 0.0094%.]Therefore, ait present, the possibility of false Dositives in screening positive
cases of anti-HIV antibody tests is very high, especially tested with EIA. Neverthe ess, only
30% of all screening positive cases were reported to be ordered for WB every year and
this would be quite a setsous problem for the actual false positive per sons in Japan.
K. Osato, Osaka Prefectural Bandai Clinic for STD, 3- I -45 Bmda Higashi, Sumiyoshi -ku,
Osaka, 558 Japan Telephone: [phone] Fax: [phone]
Mo.B.I 179
FULLY AUTOMATED CHEMILUMINESCENCE ASSAY FOR THE DETECTION OF
ANTIBODY TO HUMAN IMMUNODEFICIENCY VIRUS TYPE- I (HIV- I) /TYPE-2(HIV-2)
Matsuda, uzo,Tsukamoto M, Gohchi K, Kawasugr K, Gotoh FI', Kaw,rmoto M' Takzawa
N**, KannoT*-. 'Departroent of MedcineTerkyo Un versIty School of Medicine,Toky o;
Central Research Laboratory, lat ron Laboratories Inc., Chiba; '*Departrment of
Laboratory Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
Objective: We developed a new and fast automated chemiluminescence asay for the
detection of antihuman immunodeficiency virus type- I (HIV I)/-type-2 (DIV-2) antibdy
and evaluated this assay system as a screening test.
Methods & Results: Firstly we tested commercially available panel sera, includ ng 39 anti
HIV-I antibody positive and 14 anti HIV-2 antibody positive sera with this system to vaii
date the system and found that all sera were positive by this method. Next, we tested 88
patients who were found to be positive for HIV I antibody: 206 HIV I antibedy negative
disease controls; and 2,000 healthy controls. We also evaluated ant coagulated whole blood
fromr HIV positive patients and from controls without HIV- I nfection. All ant-HIV I ant!body positive patients tested positive with this method, and I but one disease/healthy control were negative for HIV I antibody None of the anti-coagulated whole blood samples
gave either a false positive or negative reaction with this system.
Conclusions: We conclude that this new and fast automated test system is efficient for the
screening of HIV -I/HIV 2 antibodyf However, we need to cornduct further studies employing
larger samples from anti -HIV I antibody- and/or anti-HIV 2 antibody -positive patients,
including those with subtype O infection as well as -antibody negative patients to determine
the precise specificity and sensitivity of this system.
Juzo Matsuda, Department of medic ne, Teikyo University Sc hool of Medicne, I I-1. Kaga 2
Chome Itabashi-Ku, Tokyo 173 Japan, Telephone: [phone] I Fax [phone]
Mo.B. I 180
EARLIER PATIENT IDENTIFICATION THROUGH ANONYMOUS CD4 SERVICE
Nookha i Somboon, Phanuphak P Hanvanich M. Program on AIDS,Tha Red Cross Soaiety
Thailand
Objective: To study the benefit of the new concept of having ain anonymous CD4 service to
patients with HIV infection as compared to the conventional (D4 service at an AIDS chnc
Method: Demographic and clinical data of 249 HIV-infected patients who had their first
CD4 cell count at the newly established Thai Red Cross Anonymous CD4 Clinic n Bangkok
during August to December 1995 were compared to those from 194 patients who also
had their CD4 cell count for the first time but at the nearby /AIDS Clnic of Chulalongkorn
University Hospital during the same period of time.
Result: Characterstics of the patients from both clinic are shown in the-Table.

0
4J
0
E.

Parameter Anonymous CD4 Clinic
Number 249
% Male 62.5
Risk behavior:
* Heterosexual 231 (92.8%)
* Homosexual/Bisexual 16 (6.4%)
* IVDU 2 (0.8%)
Clinical staging:
* Asymptomatic / PGL 148 (59.4%)
* ARC 90 (36.2%)
* AIDS I 1 (4.4%)
Inital CD4% 12.5 ~ 8.1
Initial CD4-absolute number 287 ~ 230

AIDS Clinic
194
73.7
181 (93.3%)
8 (4. 1%)
5 (2.6%)
49 (25.3%)
80 (41.2%)
65 (33.5%)
10.2+8.0
192 ~+ 17c9

P value

N.S.
--0.05
>0.05
>0.05

Conclusion: As compared to hospital patients, those who came to the Anonymous CD4
Clinic were at a much earlier stage of the disease which was reflected by a higher CD4 cell

85