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

1028 Abstracts 60158-60163

12th World AIDS Conference

60158 Incidence of cervical dysplaysia among HIV-infected
women
Kwan Kew Lai. Univerity of Massachussetts Medical Ctr 55 Lake Avenue North,
Worcester, Ma, USA
Objectives: To study the incidence of cervical dysplaysia (CD) among HIVinfected women (HIVW) over time.
Design: Prospective study
Methods: Pelvic examinations and Papanicolaou smears were performed on
HIVW followed in the HIV clinic. Patients whose pap smears showed CD or
cellular changes consistent with Human Papilloma virus (HPV) infections were
referred to the gynecology clinic for colposcopy.
Results: 58 HIVW with a mean age of 38 years (range 23-59) were followed
over a period of 35 months (range 6-84). Thirty-two of 58 (55%) acquired HIV
infection through heterosexual contact. Thirty-four (59%) had Pap smear showing
CD, 17 of whom (50%) had previous history of CD. The remaining 24 HIVW
continued to have normal Pap smears. Of these 34 women with CD, 24 (71%)
had colposcopy, CD was confirmed in 19, 3 with HPV infections, 1 had chronic
cervicitis, and 1 had a normal colposcopy. Nine had cone biopsy, all were confirmed to have CD. Twenty-four of 34 HIVW (71%) with CD had evidence of HPV
infection on Pap Smears, colposcopy, or cone biopsy. The mean CD4 count and
viral load for HIVW with CD were 301 cell/mm3 and 104 copies of RNA/ml and
that for HIVW with normal Pap smears were 295 cells/mm and 2 x 104 copies/ml.
Conclusions: Cervical dysplaysia was observed in 59% of this group of HIVW.
Cellular changes consistent with HPV infection were present in 71% of HIVW with
CD. HIVW have a high prevalence of CD and HPV infection.
60159 The effects of controlled ethanol ingestion on HIV RNA
levels and CD4 counts in HIV positive subjects
Jack Stapleton, R.T. Cook, D. Klinzman, J. Katseres, R. Coleman, M. Pfaller,
B. Alden. Univ of Iowa, 200 Hawkins Drive SW 54-GH Iowa City, IA, USA
Background: There are conflicting data on the effect of alcohol on the in vitro
replication of HIV in lymphocytes of HIV negative people following ingestion of
short term ethanol (ETOH). Because alcohol use is extremely common among all
people, HIV positive and HIV negative, characterization of the effects of ETOH
on HIV is important. We directly evaluated the effect of ETOH ingestion on viral
load and CD4 counts among 18 individuals with HIV infection.
Methods: 18 HIV positive patients with CD4 > 100, detectable HIV RNA, and
on stable anti-retroviral therapy were studied. All subjects were light to moderate
drinkers. Samples for HIV RNA quantitation (Roche Amplicor) and Flow Cytometry were obtained, and all alcohol ingestion was discontinued. 2 weeks later, a
repeat plasma was obtained, and 1 week later patients were started on daily, 0.4
grams/kg ETOH in a soft drink. Daily ETOH was continued for 4 weeks. Blood
samples from subjects were obtained weekly during ETOH ingestion, and for 3
weeks following discontinuation of ETOH. Samples were stored at - 70" C. CD4,
CD8, electrolytes, CBC, glucose, LFT's were also monitored.
Results: Subjects tolerated the daily ETOH well, with no subjects discontinuing
the study. There were no hematologic or biochemical adverse events in this study.
As a group, the HIV RNA rose 0.4 loglo between the baseline and following 4
weeks of ETOH ingestion (p < 0.05). This was not seen following one or 2
weeks of ETOH, and resolved following discontinuation of ETOH for three weeks.
Individual variation was significant, with 10 of 18 subjects having no changes or
even a slight decrease in HIV RNA level. Two subjects had >1 log increase in
HIV RNA, which led to the overall increase for the group. CD4 counts did not
change during ETOH.
Conclusions: Although some in vitro data suggest that small amounts of
ethanol may enhance HIV replication, the results of our controlled clinical trial
found that low dose ethanol only slightly increased HIV RNA levels (0.4 log
increase). The dose of ethanol used was approximately equal to 2 beers per day
(for a 70 kg person). The increased viral load was not uniform among subjects,
and ethanol at this dose does not appear to cause enhanced HIV replication in
all subjects. A shorter duration, higher dose trial of ethanol is underway.
60160 Thromboembolic disease associated with initiation of
protease inhibitor therapy
Sarah George1, S. Swindells2, R. Knudson3, J.T. Stapleton4. 4University of
Iowa, 1Dept. Internal Med., 200 Hawkins Dr., Iowa City, IA; 2Univ. of Nebraska
Medical Ctr., Omaha, NE; 3Family Health Ctr., Coralville, IA, USA
Background: Thromboembolic events are unusual in patients infected with HIV.
We reviewed our experience in 660 of our HIV infected patients treated over the
8 years prior to the availability of protease inhibitor (PRI) therapy, and found that
deep venous thrombosis (DVT) and pulmonary embolus (PE) rarely occurred (only
1 unexplained DVT). Since the advent of PRI therapy, we noticed an increased
incidence of DVT and PE among patients on PRI's.
Methods: DVT and PE were documented by venous plethysmography, venography, or V/Q scanning. Demographics, medication history, CD4 counts, viral

load, history of risk for clotting disorder, and HIV disease state were obtained by
chart review. HIV RNA was performed using the Roche Amplicor method.
Results: 6 of 783 active patients developed DVT or PE (11 total events).
5/6 patients were male. The initial thrombosis occurred between 11 and 101
days after starting PRI therapy. Not all of our 783 active patients receive PRI's,
thus the incidence of thromboembolism in our patients was greater than 0.76%.
Thromboembolism occurred following initiation of ritonavir, indinavir, nelfinavir

and saquinavir therapy. 4 of 6 patients remained inadequately anticoagulated
despite coumadin doses of up to 30 mg daily (patients on ritonavir, indinavir, and
saquinavir), and all four of these had recurrent thrombosis. The average CD4
count was 188 cells/cc3 (range: 2 to 519), and average viral load was 11,000
(3/6 were nondetectable). All of our patients with DVT/PE were ambulatory.
One patient was on oral contraceptives, and one patient had minimally elevated
anti-cardiolipin IgG. No other risk factors for thromboembolism were identified.
Conclusions: We identified an unusually high incidence of thromboembolic
events among patients receiving PRI therapy. All of these cases occurred within
101 days of initiating therapy (excluding recurrences). Among patients who discontinued PRI, no further thromboses were observed, even after discontinuation
of anticoagulants. In the setting of continued PRI therapy, inadequate anticoagulation was common, which led to recurrent DVT and PE. Our data suggest that
PRI's increase the risk of thrombogenesis.
S60161 Role of T-tropic HIV-1 V3 loop in viral entry into cells
analyzed with 3 different anti-CXCR-4 monoclonal
antibodies
Takashi Uchiyama1, Hitoshi Sakaida2, T.H. Hori2, A.Y. Yonezawa2, A.S. Satoh3,
O.Y. Yoshie3, T.H. Hattori2, T.U. Uchiyama2. 153 Shogoin-Kawaramachi, Sakyo,
Kyoto; 2Institute for Virus Res., Kyoto Univ., Kyotto; 3Shionogi Institute for
Medical Science, Osaka, Japan
Objectives and Methods: In order to detect expression of CXCR-4 at the single
cell level and dissect post-binding events of HIV-1 infection, we generated three
mAbs against human CXCR-4, one of which immunoprecipitated a specific 47 kD
component from CXCR-4+ cells. In the present study, we examined the effects of
these mAbs on env-mediated fusion and infection of T-tropic and M-tropic viruses.
In parallel, in order to understand the precise mechanism of the env-mediated
fusion and entry of HIV-1, we investigated the direct binding of the V3 region of
T-tropic HIV-1 to CXCR-4 by using synthesized V3 peptides and the mAbs.
Results: [1] (1) Pretreatment with the three mAbs against CXCR-4 inhibited
SDF-1-induced Ca++ mobilization. (2) The three mAbs suppressed cell fusion
mediated by envelope proteins of a T-tropic virus (NL432) but not of an M-tropic
viruses (JRCSF). (3) The three mAbs suppressed infection of a T-tropic virus
(NL432), but not of an M-tropic virus (NL162). [2] (1) V3-BH10 blocked the
binding of IVR7 to CXCR-4 in a dose dependent manner. (2) Pretreatment of
V3-BH10 prevented the SDF-1-induced Ca++ mobilization by nearly 90%. (3)
V3-BH10 inhibited the infection of HIV-IIIB to MT-4 cells in a dose dependent
manner.
Conclusion: Our data confirm that CXCR-4 is derectly involved in env-mediated entry and fusion of T-tropic HIV-1 and strongly suggest the interaction
between V3 loop of T-tropic HIV-1 gp120 and CXCR-4 in viral infection.
60162 1 A critical assessment of the HIV accidental exposure
prophylaxis program in British Columbia, Canada
Ann Beardsell, C. Lai, R. Hogg, W.A. McLeod. St Pauls Hospital Pharmacy
Dept. 1081 Burrard St Vancouver, Canada
Objectives: To conduct a critical assessment of the accessibility, utilization and
appropriate clinical follow-through associated with the HIV Accidental Exposure
Prophylaxis Program (HAEPP) currently in place in British Columbia by the B.C.
Centre for Excellence in HIV/AIDS.
Design: Prospective, uncontrolled study.
Methods: Approximately 400 starter kits containing a 5-day supply of zidovudine and lamivudine have been distributed throughout British Columbia into
emergency departments, rural health centres and remote nursing stations for use
as prophylaxis following a potential occupational or community HIV exposure.
During a 6-week period, all patients initiating a kit were identified and followed
by patient and/or physician interviews for 2 months. Information collected for
each patient included: type of potential exposure, HIV status of source, time
from exposure to initiation of therapy, reasons for stopping medication prior to
the completion of the 28-day course, problems with accessing the medication or
information.
Results: To date, a total of 140 kits have been dispensed with consent for
follow-up obtained in 105 cases (75%). Only 60 patients (40%) have obtained the
remaining 23-day supplies. The primary type of exposure is needlestick, both in
healthcare and community settings (70%).
Conclusion: The HAEP program provides access to antiretroviral therapies
following an potential exposure to HIV throughout the province of B.C.. The
program allows time for the patient and physican to assess the risk and determine whether continued therapy is appropriate and provides clinical support for
exposure management.
160163 HIV-related risk variables and condom use among
psychiatrically diagnosed adolescents
Larry Brown1, K.J. Lourie1, M.B. Danovsky2, A. Stermock3. 1 Child Psychiatry,

Rhode Island Hospital/Brown University School of Medicine, 593 Eddy Street,
Providence, Rhode Island; 2Valley Children's Hospital, Fresno, CA; 3Children's
Health Care of Minnesota, Mineapolis, MN, USA
Objectives: To determine the risk factors associated with condom use and other
HIV-related behaviors and attitudes among psychiatrically diagnosed adolescents.
Design: Cross-sectional study.