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

12th World AIDS Conference

Abstracts 60196-60200 1035

Methods: Nine HIV-infected individuals with cytomegalovirus (CMV) infection
or Progressive Multifocal Leukoencephalopathy (PML) were treated with combination therapy of ganciclovir and cidofovir for a median of 94 days. Pre and post
creatinine, absolute neutrophil count, hemoglobin, and platelet counts were evaluated. Results: Eight of nine patients completed treatment without progression
of CMV retinitis. No patients discontinued therapy due to an adverse event. The
median laboratory values before and after treatment and their p-values were:
creatinine, 1.1 mg/dl and 1.3 mg/dl (p = 0.65); absolute neutrophil count (ANC),
1,952 cells/mm3 and 1,585 cells/mm3 (p = 0.53); hemoglobin, 13.1 gm/dl and
13.4 gm/dl (p = 0.90); platelets, 1.60 x 105 cells/mm3 and 1.69 x 105 cells/mm3
(p = 0.65). There was one anemic and one thrombocytopenic episode.
Conclusion: These data suggest that combination therapy with ganciclovir and
cidofovir is well tolerated and is as efficacious as monotherapy.
60196 Prevalence of HIV infection among pregnant women in
Japan
Masaru Shimizul, K. Osada', T. Suzuki2, M. Morita2, J. Tanaka3, H. Yosizawa3.
'Tokyo Women's Medical College, Kawada-Cho 8-1 Shinijuku-Ku, Tokyo;
2Kitazato Institute, Tokyo; 3Hiroshima University Yosikawa, Japan
Objective: To compare the prevelance of HIV infection among pregnant women
to that among the general population, especially that among voluntary, unremunerated blood donors. These data could help clarify whether the reports from
the AIDS Surveillance Committee (ASC) of the Ministry of Health and Welfare
(MOHW) reflect the actual situation of HIV infection in our society.
Design: Prospective study.
Methods: We started this investigation in 1988, when HIV infection through
heterosexual contacts had not yet become a focus of public attention in Japan.
Asking medical staff in several hospitals to provide us with information if they
perform tests for anti-HIV antibody (HIVAb) among pregnant women, we request
the report of positive test results if possible. Thereafter, we tried to expand the
participating hospitals throughout the country. In 1996, we were able to collect
the data from 30 of 48 prefectures.
Result: None of 105,373 pregnant women tested prior to 1995 were positive
for HIVAb. In 1996, six of 112,815 pregnant women (5.3/100 x 103) were positive
for HIVAb. This was almost equal to 10% of total number of pregnant women
who gave birth to newborns. Maternal nationality was Japanese in 2, foreign in 3
and unknown in 1 case. The frequency was much higher than 2.1/100 x 103 and
0.76/100 x 103 among blood donors in the metropolitan area and nationwide,
respectively. Three prefectures offered free HIVAb tests to all pregnant women
starting in 1995 or 1996.
Conclusion: Considering the much higher incidence of HIV infection among
pregnant women than among blood donors and the fact that at least 25 babies infected with HIV through mother-to-infant transmission have been already reported
in Japan, it is recommended to provide all pregnant women with an opportuniny
to undergo HIV testing.
| 60197 1 Mathematical model to estimate the probability of being
infected by HIV
Jair Ferreira', M.B. Wagner', A.C. Gerbase2. 1 Universidade do Rio Grande do
Sul, Eng. Alvaro Nunez. Pereire, 400 Ap. 303, 90570-110, Porto Alegre, Brazil;
2World Health Organization, Geneva, Switzerland
The objective of this study was to calculate the probability of being infected presented by a subject who had, at random, a given number of potential exposures
to HIV, like parenteral contacts with blood or sexual intercourse episodes.
It is demonstrated, mathematically, that the probability of being infected (Py) is
given by the formula:
Py = (xc) x Vx x (1 V x x1 x - (1 -F)x]
x 0
where c is the number of potential exposures, x is the actual number of exposures
(which could vary from zero to c) V is the prevalence of HIV infection and F
is the infectivity of HIV, that means, the probability of being infected in a single
exposure.
Simulations were made, with different values of c, V and F, corresponding to
different epidemiological situations and different kinds of exposures to HIV.
Conclusion: Simulations show that, depending on the number of potential exposures and on the prevalence of HIV infection, the probability of being infected
could be very high, including for those kinds of exposures in which the infectivity
of HIV is low. Among other uses, the appliance of the model could be helpful to
decide about implementing or not quimioprophylaxis after a parenteral accident
with blood of unknown HIV test results.
60198 Parent/child contact issues for gay fathers with HIV/AIDS
and their children

Lyle Millard. Barnardos Castle Project, 67 Bayswater Grove, Leeds, England
Issues: This paper considers the arguments for and against contact between
children and their gay fathers with HIV/AIDS.
Project: A review of American and European literature and research relating
to parent/child contact, gay parenting and gay fathers, and the needs of children
affected by HIV/AIDS.

The paper recognises the child's right to contact with a parent, and notes the
benefits of contact with a father, regardless of his sexuality or HIV/AIDS status.
The needs of the child affected by HIV/AIDS are discussed.
Professional issues addressed include, mediation between parents, working
with gay fathers with HIV/AIDS and their family's and direct work with children affected by HIV/AIDS. Prejudicial attitudes are challenged, in particular the
relationship between gay men and children.
60199 AIDS prevention for migrant populations in Switzerland:
Different communities, different approaches
Raphaelle Carron. Federal Office of Public Health, Migration Unit 3003, Bern,
Switzerland
Objectives: Six years of experience with the setting up and implementation at a
national level of AIDS prevention measures for populations of different national
origins in Switzerland have enabled us to identify the framework conditions and
infrastructure (cultural, structural, public health) that ensure the participation and
involvement of the various comunities in the programs. Principles of intervention,
methods applied and consequences of these activies within the communities
(number and kind of actions undertaken and the manner in which they were
introduced) will all be discussed.
Methodology: Presentation of the principles underlying the implementation
of a targeted program and arguments relative to it. Description of the measures taken: Common for all comunities and/or specific to particular targeted
communities/groups. Description of the particularities of each target population/identification of necessary adjustments. Description of the effects on the
communities and their implications (projects, multiplicators, structures, media).
Principal Results: The basic principles were very simple: involving communities, rousing their concern, getting them to "adopt" prevention as their own
cause. The structural organisation of the various communities is a dicisive factor
for the feasibility of activities. Where community structures exist, the institutional
community network plays a privileged role. In more recent or less structured
communities the identification of "key persons" and the use of particular "settings"
appear more effective. Thus, measures and projects differ widely: flexibility and
inter-penetration of the health issues at hand were well received and followed
by extensive participation. In other, more structured communities a process of
empowerment leads to a takeover of prevention by the community itself.
Conclusion: It is indispensable to analyse the processes occurring in this
prevention program, which presuppose that the responses and the participation
of the target population adapt continously. This flexiblity is ensured by means of
several recommendations (given in conclusion to the abstract).
60200 The PEP Team: A multidisciplinary team approach to
provide continuous coverage for post-exposure
prophylaxis in an urban university hospital setting
Joy Zeh1, M.T. Wong2, F.J. Torterella3, J.S. Kaatz2, P. Allen3, L.G. Kaplowitz2,
C. Weiir-Wiggins2. 'Box 980147, VCU HIIV/AIDS Center Richmond, Virginia
23298-0147, 2VCU HIV/AIDS Center, & Medical College of Virginia Hospitals
Richmond VA; 3Medical College of Virginia Hospitals Employee Health
Richmond VA, USA
Issues: The Medical College of Virginia Hospitals (MCVH) in Richmond, Virginia
is an 800 bed hospital, tertiary care center, and regional referral center for the
central Virginia area. It is affiliated with Virginia Commonwealth University (VCU),
a large urban public institution with programs in Medicine, Nursing, Dentistry,
Pharmacy, and Allied Health Professions. When Employee Health closed for the
day, MCVH employees and VCU students and staff who became exposed to potentially infectious body fluids on the job or in the clinical setting were referred to
the MCVH Emergency Room (ER) where they experienced long waits. ER physicians were not always familiar with recommendations for prompt Post-Exposure
Prophylaxis (PEP) to decrease the risk of HIV infection.
Project: A Post-Exposure Team was recruited from Physicians and staff of
MCVH Epidemiology, Employee Health, Infectious Disease Clinic, and the VCU
HIV/AIDS Center. The multidisciplinary team approach designates nonphysician
health care personnel to provide first response by telephone to calls to the PEP
Team pager. Physicians provide back-up as needed for consultation and prescribing medication. The MCVH inpatient pharmacy has prepared PEP medication
starter packets with a 3-day supply of antiretrovirals that can be dispensed in only
a few minutes.
Results: The PEP Team has been in existence since July 1997. Current composition of the team includes 1 Physician Assistant, 4 Nurse Practitioners, and 6
Registered Nurses who rotate taking first pager call by telephone. 5 Physicians
rotate back-up second call as needed for consultation or to prescribe medications. Employees receive ongoing follow-up in Employee Health. Employees are
pleased with prompt access to expert advice they receive while remaining on
their work units. The multidisciplinary concept enables more personnel to share
call responsibility.
Lessons Learned: A multidisciplinary on-call Post-Exposure Prophylaxis re
sponse team providing immediate telephone contact to health care employees
and students who have been exposed to potentially infectious body fluids is
an effective way to provide prompt, high quality, up-to-date management of
occupational exposures.