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

12th World AIDS Conference

Abstracts 60174-60178 1031

include 75.1% Caucasians, 8.0% Hispanics, and 2.4% African Americans with
others representing less than 2.0% each. The mean age is 42.8 years. The
predominant HIV infection risk factor was sexual contact (96.3%), with 93.5%
having had homosexual/bisexual contact. Over 50% of the participants are college-educated. The percentages of individuals who work full-time versus those
who are disabled are 46.5% and 42.5%, respectively. The mean number of years
living with HIV is 7.2. Most patients are antiretroviral-experienced (76.3%) with
93.5% reporting exposure to zidovudine, 91.1% to lamivudine, 69.4% to stavudine, 65.0% to indinavir, 57.0% to zalcitabine, 56.2% to didanosine, and 53.0% to
saquinavir. The mean CD4 count at entry was 259.7 cells/mm3 and the mean viral
load was 3162 copies/ml. Of the past HIV-related illnesses reported at baseline,
14.6% experienced dermatological, 10.5% GI, 7.3% respiratory, and 27.4% other
conditions.
Conclusion: This large study cohort will provide important information on
changes in an HIV population over time, including current antiretroviral usage and
its impact on disease progression.
60174 A model for improved human subjects protection
Mark Mischan, Ronald Gagne1, E. Bisarra2, P. Patch3, N.J. Williams4. 4324 35th
Street, San Diego, CA; ' Quality Assurance, 2Outreach, 3Secretary - HIV/AIDS
Consumer Council, San Diego; 4 County Office of AIDS Coordination, San Diego,
CA, USA
Issue: Many studies of people living with HIV/AIDS are conducted with little or no
attention to whether those involved in the study might be harmed through their
participation.
Project: The number of studies of people with HIV/AIDS has increased with the
growing numbers of AIDS services and programs and the availability of computer
technology. As part of planning and evaluation, most HIV/AIDS programs conduct
"field research" studies such as community needs assessments, behavioral risk
studies, pretest and post-test surveys, etc. Unless they are part of formal university research, these studies do not undergo documented review of their potential
harm to participants. Formal attention to human subjects protection issues is
included in the HIV/AIDS Consumer Needs Assessment in San Diego, California,
USA. Community discussion on protection issues, a written Human Subjects
Protection Plan, and training for interviewers are some of the strategies used to
prevent harm to people with HIV/AIDS who participate in this biannual survey.
Results:More than 30 agencies and community groups assist in conducting the
San Diego HIV/AIDS Consumer Needs Assessment. Using both survey and focus group methods, this Needs Assessment collects information about HIV/AIDS
services from over 1000 people every two years. The formal Human Subjects
Protection Plan reduces the chance of harm to survey participants and provides
consistency to interviewer training and data collection.
Lessons Learned: People with HIV/AIDS can be harmed by participating in
surveys intended to help develop services for them. Only by carefully analyzing potential risks to confidentiality, human rights, psychological health, etc. can
an effective Human Subjects Protection Plan be effective in reducing risks of
participation in surveys and other program-related research.
60175 The Catholic parish as welcoming and healing
community for those affected by HIV/AIDS
Robert Vitillo. 4001 Fourteenth Street, N.E. Washington D.C., USA
The Catholic parish is the weekly gathering place for most of the sixty million
Catholics in the United States, who constitute almost one quarter of the US
population. These 19,700 parishes are focal points for education, services, and
social justice advocacy. In order to identify key factors for success in organizing
HIV/AIDS ministry in Catholic parishes, the National Catholic AIDS Network and
Catholic Charities USA launched an intensive study of more than 50 parish-based
HIV/AIDS education and service efforts in different parts of the country. Based
on their findings, these organizations have designed a special training manual
and have implemented a training of trainers program to prepare regionally-based
mentors who can promote the development of additional HIV/AIDS ministry efforts.
In the development of parish-based HIV/AIDS services, priority consideration
must be given to the role of clergy; recruitment, training and ongoing support
of volunteers; the inclusion of practical, emotional, and spiritual support in the
programs; and the integration of HIV/AIDS themes in the general prayers.
60176 Plasma cell granuloma presenting as transverse myelitis
in an HIV patient
Carlos H. Ramirez-Ronda1, C. Navarro, H. Quinones, D. Toro, C. Baldizon,
A. Betancourt. San Juan VAMC - Univ. Puerto Rico School Medicine, San Juan;
181 Mirador St, Paseo Alto, San Juan, PR, Puerto Rico (USA)
Purpose: To present a case of a plasma cell granuloma in an HIV patient on no
medications.
Methods/Results: The patient is a 44 year old male, with history of IV drug

use of many years, that was diagnosed with HIV disease in 1995 followed outside
the VA system, taking no medications, that presents to the VA with difficulty
walking. The symptoms of weakness in the lower extremities, associated with difficulty emptying the urinary bladder as well as difficulty with defecation worsened
gradually over several weeks to months. The patient had episodes of diarrhea,
undiagnosed, and in the recent past ingested raw eggs. The patient presented
with a BP of 150/90, pulse 95 and temperature 98 F. The physical examination

was unremarkable except for the findings of systolic murmur, grad II/VI in left
sternal border, and distention of the abdomen with decreased bowel sound.
Neurologic examination demonstrated a sensory level at T12-L1 bilaterally. Vibration and propriception were preserved in the left leg, but absent in the right
leg. Motor function presented flaccid paraparesis at 1/5 (to pain withdrawal). No
reflexes in the lower extremities. Initial work up demonstrated a HB of 11.7 and
WBC count of 9,100. A flat plate of the abdomen demonstrated bowel distention
that later resolved. A CT of the spine was done showing discogenic changes,
this was re-confirmed with an MRI that also demonstrated a soft tissue density.
The MRI demonstrated a low thoracic extra medullary compression of the spinal
cord (epidural lesion). Blood culture grew Salmonella cholerasuis. The patient
was started on IV ciprofloxacin and improved. The lesion was removed by neurosurgery and the pathologic diagnosis was plasma cell granuloma. Serologic
studies for DNA viruses, EM of the lesion and special stains for fungi, etc. were
not diagnostic.
Conclusions: This is a very rare case of plasma cell granuloma of the spinal
canal in an HIV patient that coincidentally had S. cholerasuis bacteremia, the first
case involving the spinal canal and the second in an HIV patient.
60177 Case control study of gender identity disorder and HIV
disease
Susanne A. Pulimood1, J.A. Cohn, K.L. Wright, L.R. Crane. Wayne State
University; 74201 St. Antoine UHC-7D, Detroit, Ml, USA
Objectives: To compare the utilization of health care services, clinical characteristics and survival of HIV infected persons with gender identity disorder (GID)
with HIV infected controls.
Methods: Retrospective case control study. Patients with HIV infection and
gender identity disorder by DSM-IV criteria seen in the HIV/AIDS program of
Wayne State University (WSU) between 1993 and 1997 were the cases. 2 male
and 2 female patients with HIV infection matched within 2 years of age and within
6 months of entry into care at WSU were selected as controls for each case.
Results: There were no differences in the race, education, employment, insurance status, prevalence of homelessness, substance abuse, mental illness or
overall prevalence of sexually transmitted disease (STD) between the 15 cases
and the 60 controls. Patients with GID presented to WSU with a higher rate of
CDC defined AIDS (67% vs 37%, p = 0.05), and a lower CD4+ cell count (median 169 vs 319, p = 0.06) than controls. Subjects and controls were under our
observation for a median of 2.4 years (range 0-8 yrs). There were no differences
in the number of scheduled visits or the proportion of missed visits while under
our care. GID patients and controls received anti retroviral therapy and protease
inhibitor therapy at the same rate. While under our care, certain illnesses occurred
more often among GID patients than controls: PCP (7 episodes vs 3 episodes,
p = 0.001); HIV encephalopathy (2 vs 1, p = 0.05); and KS (1 vs 0, p = 0.05).
However, there was no difference in the survival between the cases and controls
by Kaplan Meier analysis or proportional hazards modeling.
Conclusions: Patients with gender identity disorder present at a later stage
of HIV disease than the controls suggesting a delay in access to health care.
The patients with GID are similar to the controls with regards to demography,
prevalence of mental illness, sexually transmitted diseases and substance abuse.
Once in care, the survival experience of the GID patients was the same as for
the controls with HIV infection.
60178 Changing highly active antiretroviral therapy (HAART)
and its effects on viral load (VL) and CD4 count
Kimberly Shriner', Kristin Karlyn, J. Lukas, D. Brahmbhatt, M. Friedman,
R. Neal, L. Smillie. Huntington Memorial Hospital, 150 Bellefontaine #203,
Pasadena, CA, USA
Objectives: To evaluate the indications for changes in HAART and its effects on
HIV VL and CD4 response.
Design: Review of medical records of patients in a community based clinic and
private practice.
Methods: Medical records of 69 adult patients with confirmed HIV infection and
who were receiving HAART were reviewed. HAART regimes were considered
changed with alterations of two or more medications including protease inhibitors
(PI). We evaluated: 1) indications for changing HAART; 2) clinical characteristics
of patients who required changes in HAART; 3) virologic response to changes in
HAART and 4) CD4 response to changes in HAART.
Results: Twenty three of the 69 patients (33%) required changes in HAART. Of
those patients requiring changes in HAART, 60% (14/23) required more than one
change in their entire drug regimen. Drug intolerance accounted for 30% of the
changes. Increasing VL or decreasing CD4 count accounted for 70% of changes
in HAART. Patients requiring changes in HAART were more likely to have higher
VL, lower CD4 counts and a history of previous antiretroviral therapy with non- PI
regimens. 87% of the changes resulted in an initial decline in VL. 60% of HAART
changes resulted in an increase in CD4 cells.
Conclusion: Changing HAART in the face of drug intolerance or poor labora
tory parameters in HIV patients is frequently required but can effectively maintain
viral suppression and a positive CD4 response.