Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

1024 Abstracts 60132-60136

12th World AIDS Conference

Results: Work at multiple system levels is challenging and rewarding at the
same time. A key variable is the number of subsystems involved. At the interface
between counselor and client a great deal can be achieved by involving family
members and friends. At the institution level, where medical teams, psycho-social
teams, hospital staff, families, and clients interface boundaries get blurred and
the capacity for system problems expands dramatically. At the societal level, as
in the Public Interest lawsuit exemplified in this paper, with several institutions
involved, the situation can get harder.
Lessons Learned: Different strategies need to be employed at diferent system
levels to prevent potential failures. In the event of system failure, computer error
management options, "Abort", "Retry" and "Ignore" can be useful, if not the only
solutions.
60132 Chemokine, chemokine receptor, cytokine and monokine
levels in HIV-1-infected patients with CD4+ T lymphocytes
of 200/mm3
Olivier Benveniste1, N. Dereuddre-Bosquet2, P. Clayette2, M. Martin2,
C. Leport3, J.L. Vilde3, D. Dormont2. 1Service des des Maladies Infectieuses,
Hopital Bichat, 75018 Paris; 2Service de Neurovirologie CEA IPSC, Fontenay
Aux Rose; 3Service des Maladies Infectieuses APHP, Paris, France
Objectives: To look for possible correlations of cytokines (CK), monokines (MK),
chemokines (CHK) and chemokine-receptors (CHK-R) with viral loads in HIV-1
infected patients.
Design: Prospective, pilot study on 9 patients (4 CDC stage B and 5 stage C)
where these parameters were measured repeatedly.
Patients and Methods: Their mean CD4+ was 218 ~ 20/mm3 and was not
different between the two groups. All patients (exept one) were treated by nucleosid analogs. Blood was drawn 2 (n = 4), 3 (n = 4) or 4 (n = 1) times consecutively
over a 3 month-period without any opportunistic infection and/or immunologic
progression. RT-PCR was performed to quantify in PBMC mRNA expression
levels of CHK (MIP-1 a, MIP-1/, RANTES), CHK-R (CCR-5, CXCR-4), type 1
CK (IL-2, IL-12p40, IFN-y), type 2 CK (IL-4, IL-10) and MK (IL-1l, IL-6, TNF-a).
Cellular and plasma viral loads were quantified respectively by DNA HIV PCR
and NASBA.
Results: No patient from the two groups exhibited a detectable level of mRNA
expression of type 1 CK. Others CK, MK, CHK and CHK-R mRNA were detected
in all patients, but great variations of a given parameter in a given patient were
observed over time, especially for MK, and when samples were separated by
more than one week. However, positive correlation was observed between MK
and CHK, CHK and their receptors. Concerning the comparison of the 4 stage B
and 5 stage C patients, only MIP-1P levels were significantly decreased in stage
C patients (p < 0.0043, Mann-Whitney test). HIV DNA loads were slightly higher
in stage C patients (p < 0.023) and were negatively correlated with IL-10 mRNA
levels (r = -0.49, p < 0.013).
Conclusion: In spite of the variability observed, this study outlines: 1) the
feasability of quantification of mRNA expression levels to assor the functions of
CD4+ T lymphocytes and 2) the presumed role in vivo of MIP-lfp and IL-10 in the
pathogenesis of AIDS, two molecules able to inhibit HIV replication in vitro.
60133 Provision of innovative community based housing for
people at risk with AIDS dementia complex
Andrew Clark, M. Spencer, M.K. Jackson. Ageing And Disability Department,
Level 13, 83 Clarence St, Sydney, NSW 2000; Brown Sisters; Occupational
Therapy Dept., St Leonards, Australia
Issues: This paper describes the development, implementation and operation
of an innovative community based housing project who are at risk with AIDS
dementia complex.
Project: As a result of a crisis in care for a young man at high risk with AIDS
dementia, a model of care was developed by local health workers to appropriatley
manage his needs. This model was premised on the belief that an individual's
needs and choices must be central to service delivery. As well, the service must be
able to adapt to the individual's location and housing type. It was also recognised
that care must be provided within the constraints of public health legislation and
harm minimisation principles. Funding was sought and received from the State
Department of Health.
Results: As a result the young man was housed in his own home with support
provided by paid workers from a local neighbourhood community centre, which
now administers the service. This model has operated effectively for 3 years and
has assisted 5 people all of whom were at high risk with complex care needs.
Lessons Learned: The authors believe that this model of care is an appropriate and innovative response to care needs of people at risk with AIDS dementia
complex.
60134 Pain in clients referred from a HIV unit in Sydney,
Australia, to community nurses, 1993-1995

Adrienne Lucey 2, B. Bicknell3, D. Burke3. Flat 5 70 Albion Street Randwick,
New South Wales; 2Royal South Sydney CHC Sesahs, Sydney; 3Australian
Catholic University, Sydney, Australia
Objectives: The purpose of this study was to identify the conditions (diagnoses
and symptoms) and sites related to pain recently experienced by clients with

advanced HIV disease who were referred to GCNs from an inpatient HIV Unit
over a two year period.
Design: Descriptive, retrospective study.
Methods: Data of 73 clients received from an inpatient HIV Unit and recorded
on 171 community nursing referral forms (n = 171) between June, 1993 and
June, 1995 was retrospectively reviewed. The data related to the pain of these
73 clients who died within the study period was reviewed and analysed using
descriptive statistics and cross tabulations.
Results: Pain was the most common symptom, occurring in 45 (61.6%) clients
or 84 (49.1%) referrals. The most common condition related to pain was headache
(28% of clients or 17% of referrals) followed by cytomegalovirus disease, diarrhoea, odynophagia, hepatosplenomegaly and bacterial chest infection. The most
common pain site was abdomen (38.4% of clients or 24.6% of referrals) followed
by head, pleuritic chest pain and other non-cardiac chest pain. On crosstabulation
of the most common diagnoses, symptoms and sites related to pain (excluding the
symptom of headache with the pain site of head), no kappa score demonstrated
significant concordance.
Conclusion: The lack of concordance between the variables in this study may
reflect the potential for concurrent acute, chronic and multiple pathology and/or
undiagnosed pain in clients with advanced HIV disease. The findings of this study
support the importance of the GCN assessing these variables independently, and
adds to the existing body of knowledge related to pain in clients with advanced
HIV disease who are referred to GCNs.
60135 AIDS and the impact on life expectancy in Chicago,
Illinois, USA
Steven Whitman, Y. Wang, G.D. Good. Chicago Department of Public Health,
Chicago, USA
Background: One of the most important aspects of AIDS is its impact on life
expectancy (LE). Determinations of such impact have, to our knowledge, thus far
been made only for one US city - New York. The purpose of the current study
was to extend this technique to Chicago.
Methods: Vital records files for Chicago residents in 1980 and 1990 were
employed as were MARS Census data for 1990 and MARS-like adjustments,
made by our office, on 1980 census data. Arriaga's technique for assessing
cause-of-death impact on LE was employed to identify the major factors that were
responsible for the change in LE.
Results: Between 1980 and 1990 LE in Chicago: increased significantly for
White males (from 68.1 to 69.9 years) and females (from 76.9 to 78.1 years);
remained about constant Black females (from 72.2 to 71.8 years); and decreased
significantly for Black males (from 62.4 to 60.6 years). While the decrease in
cardiovascular mortality added 201 days to Black male LE between 1980 and
1990, AIDS was responsible for a loss of 326 days over the same period. No
other cause, not even homicide, came close to having such a large impact.
Similar calculations will be presented for other race-gender groups. Results will
be compared to those for other countries that have been reported in the literature.
Conclusions: Between 1980 and 1990, the already very low LE for Black
males in Chicago declined significantly by 1.8 years. Although White males lost
almost as many LE days to AIDS (322), they gained many more days from other
causes for a net gain of 1.8 years. These changes widened even further the
already very substantial racial gap in LE in Chicago.
S60136 Discrimination and stigmatisation in relation to HIV/AIDS
Madina Nakasi Sseruwagi, E.A. Esther Agali. The AIDS Support Organisation,
Kampala, Uganda
Issue: The HIV/AIDS pandemic has resulted into another epedemic of discrimination and stigmatisation worldwide.
Project: Discrimination and stigmatisation (DS) is one of the major social consequences of the AIDS pandemic in most communities of developing countries.
This has been attributed to cultural complexities and how knowledge about surrounding HIV/AIDS of the populations. The project included people living with
AIDS (PLWAS/HIV), family members, religions and community leaders, medical
and legal professionals, employers and policy personnel to assess the farms,
causes and consequences of DS at individual, community, institutional and national levels, and redress to the problem PLWAS/HIV face as a result of their
seropositive status in society.
Results: The trend of DS in urban settings is declining tremendously due to
counselling and improved information, educatin and communication (IEC) Services from over 100% to 46 over the last 10 years. But still high to the rural
counterparts and 84% in the areas where counselling services are in infancy
stage and in some others still over 100% due to ignorance and lack of these
services.
Lessons Learned: With increased IEC and counselling services and enacted
government policies, DS is likely to reduce as one of the solutions to the pandemic
in developing countries.