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

94 Abstracts 12402-12406

12th World AIDS Conference

12402 Patterns of nausea with combination antiretroviral
therapy induction
Nancy Reynolds, J. Neidig, R. Vocca. The Ohio State University, Columbus,
Ohio, USA
Background: Combination antiretroviral drug therapies are associated with adverse secondary symptoms that can potentially limit their effectiveness. Reliable
data on the incidence and severity of nausea accompanying combination antiretroviral therapies is lacking.
Methods: A prospective time series design was used to assess the rate and
severity of nausea in a cohort of 53 HIV-infected patients who were beginning
a combination of two or more antiretroviral medications. Data were collected via
telephone at weekly intervals for 12 weeks.
Results: Thirty-six different antiretroviral regimens were observed in this cohort. The rate of nausea across regimens was greatest at week 1 (48%, n =
26) and declined progressively over time. By week 12, the rate of nausea was
only 5.6% (n = 3). Severity of nausea was ranked as moderate or severe by a
substantial proportion of patients through week 10.
Week 1 2 3 4 5 6 7 8 9 10 11 12
Rate 48% 38% 17% 11% 19% 21% 19% 9.6% 24% 15% 2% 5.5%
Severity 52% 55% 67% 50% 40% 64% 80% 67% 62% 62% 0 33%
Proportion of total cohort (n = 53) with nausea; *Proportion of cohort with nausea ranking it
as moderate or severe
Conclusions: The nausea associated with combination antiretroviral therapy
is quite common, particularly in the 1st and 2nd weeks of induction. While the incidence of nausea declines over time, severity of nausea experienced is frequently
moderate or severe. Findings suggest that strategies for modifying nausea are
needed and should be initiated at baseline. Grant Support: Ohio State University
SEED #221819 and the National Institute of Allergy and Infectious Diseases
(AACTG, #A125924).
S12403 "Buffalo Hump" associated with protease inhibitors and
use of corticoids ointment
Pompeyo Viciana, M. Dolores Prados, G. Gomez Vera, E. Cordero,
J.L. Villanueva, J. Caballero, J. Pachon. Infectious Diseases Service, University
Hospital Virgen Rocio Avenue MAnuel Siurot S/N 41013, Seville, Spain
Objective: To report another unusual depositions of fatty-like tissue at the base
of the posterior neck in the "buffalo hump" configuration in 4 patients undergoing
HAART combination for HIV infection.
Methods and Results: The 4 patients are 3 woman and 1 gay male. Average
age 34 years old. They were noted to have developed fatty-like tissue accumulations in the midline at the base of the back and upper shoulders. All patients
had been iniciated triple combination therapy in 1997, 3 with Indinavir and 1 with
Ritonavir and all patients had been extensively pretreated with dual antiretrovirals
before starting triple combination therapy. Swelling occcurred in 2 patients 4-5
months after initiating theraphy with Ritonavir and Indinavir respectively. Another
patient, after eigth mouths with Indinavir. The last patient had been treated 9
months with triple therapy (Saquinavir). After change to Indinavir, 8 month later
appear the buffalo haump. Two patients had CD4 less than 100 and another 2
had more than 500 CD4+ cell before the HAART. None of the patients appeared
cushingoid and random serum cortisols were normal. Average weight gain for 2
patients at the time of diagnosis was 17 kg. Another 2 patients the weight was the
same. All patients presented local skin pathology (1 Psoriasis case and the facial
ezcema the others), and usually using for it ointments of corticoids (3 cases) and
ketoprofeno (1 cases). The time relation within "buffalo hump" and corticoids use
wasn't uniform.

the prenatal clinic of a public hospital in Rio de Janeiro Brazil have developed
such a program. At medical consultation and during "waiting room discussion
groups" conducted by a nurse and psychologist, women are counseled on the
risk of breastfeeding and practical alternatives; they are additionally instructed on
the safe preparation of formula. Educational pamphlets are provided during these
visits. Women are encouraged to express their feelings and to raise questions
regarding breastfeeding to the medical caretakers. Formula, donated by NGOs,
churches and by private donation is made available to these women free of
charge for the first two years of the infants life.
Results: Over the last 28 months, 68 women have participated in this program
and 54 delivered their infants. These infants have not been breastfeed, and
are being followed in the pediatric outpatient clinic. While initially frustrated at
being unable to breastfeed, women have accepted this with the understanding
of its importance to their childs health. No children in this time period have been
admitted to the pediatric ward or required outpatient treatment for gastroenteritis.
Children are in good nutritional health, with normal height and weight parameters.
Lessons Learned: Even in a third world country limited resources, it has been
possible to avoid breastfeeding of HIV exposed children, where mothers were
adequately counseled and formula provided by their health care institution.
75*/12405 Care and treatment: Increased access at low cost in
Burkina Faso
Marie-Rose Sawadagol, Guiadoma Mare1, Christophe Cornu2, Vinh
Kim N'guyen3. 1IPC, BP 1184 Ouagadougou, Burkina-Faso; 2Alliance
Internationale, Paris, France; 3Alliance Internationale, Montreal, Canada
Issue: Burkina Faso has the second highest HIV prevalence in West Africa (about
10% of the sexually active population) but is one of the poorest countries in the
world (172 of 175 UNDP human development index). While the government has
made important strides in primary health care, it does not have the resources to
cope with increasing numbers of people with AIDS.
Project: The Initiative Privee et Communautaire contre le Sida au Burkina
Faso (IPC/BF) mobilises and supports community groups to respond to AIDS.
In 1997, it worked with four strong groups in different regions of the country to
launch pilot activities integrating medical and psychosocial support to about 400
PLWAs, as well as related community mobilisation and prevention activities for
about 5000 family and community members. IPC/BF was particularly committed
to developing models which were financially sustainable in the local context -
limiting the use of expensive drugs and depending largely on volunteers.
Results: All four projects have been successfully implemented and now expanded. On average, integrated care and treatment costs about $US 20 per
person per month, inclusive of drugs, training, administration and all delivery
costs. Projects managed by nurses are more cost-efficient than those run by
doctors. Quality of life and life expectancy can be improved at very low cost with
the use of generic drugs such as immodium for diarrhoea. A training package and
a list of essential HIV management drugs for NGOs has now been developed.
Six additional NGOs have been recruited to expand care coverage.
Properly supported local NGOs can be ideal conduits for effective and low cost
community care and expanded access to life management drugs, in a manner
that is financially sustainable in one of the world's poorest countries.
12406 Is targeting people with HIV through care and support
associated with sexual risk reduction?
Joan MacNeil1, G. Kilonzo2, F. Mberesero3. 1Family Health International, 2101
Wilson Blvd., Suite 700, Arlington, VA 22201, USA; 2University of Dar Es
Salaam, Dar Es Salaam; 3 Tanga AIDS Working Group, Tanga, Tanzania
Objective: To identify differences in sexual risk reduction among HIV+ individuals
enrolled in a program of enhanced care and support, compared to those who
received regular services.
Method: Using a randomized control design, 154 newly diagnosed sexually
active HIV+ individuals who had received post-test counseling in the last 4 weeks,
were assigned to a control group with access to regular health services or an experimental group which received additional counseling/home care regularly. Data
collected at baseline, 3 and 6 months examined self-reported risk behaviors,
disclosure, morbidity, and psychosocial support.
Results: Enrollment consisted of 102 females and 52 males. Over the six
month period, significant sexual risk reduction occurred among both the experimental and control groups with most of the behavior change occurring during
the first three months e.g. the key dependent variable "condom use at last intercourse" increased from 24 to 84 (significant p = <.05) for the study population.
Differences between groups and gender were minimal, however relapse was
observed between 3 and 6 months in the control group (See figure) For the
whole study population, significant increases were observed for variables on
psychosocial support, disclosure and increased chance of discrimination (p = <.010). Self-reported morbidity declined dramatically for both groups (e.g. reported
STDs declined from 35% to 13% during the first 3 months).

60
40 -|! gil^ I --Experimentl
20 | -*- Control I
Baseline 3 months 6 months
Condom Use Last Sexual Intercourse.
Conclusion: Extra counseling/home care did not result in significant difference
in sexual risk reduction. This HIV+ population as a whole significantly changed

Pre-HAART
CD4+ RNA-HIV Weight

"Buffalo Hump"
CD4+ RNA-HIV Weight

1 97 436 50 Kg 536 <200 74 Kg 3TC+d4T+IV
2 55 21500 56 Kg 538 47477 57 Kg 3TC+d4T+IDV
3 652 43000 86 Kg 551 <200 78 Kg 3TC+d4T+RTV
4 697 4767 55 Kg 290 <200 65 Kg 3TC+d4T+IDV
Conclusion: The four patients in a single HIV practice are noted to have
atypical accumulations of fatty tissue after initiating triple combination theraphy
with protease inhibitors using concomitating local corticoids and ketoprofeno. Our
cases occur with indinavir but also with ritonavir, and in advanced or not HIV
infection.
12404 Avoidance of breast feeding by HIV infected women:
Strategy of a multiprofessional team in the developing
world
Susie Nogueiral, M.F.L. Garcia1, R.T. Mercadante1, T.F. Abreu1, R.H. Oliveira1,
J.S. Lambert2. iRua Manoel Torres 520 APT 403-Bingen, Petropolis CEP
25660-315, Universidade Federal Do Rio De Janeiro Rio De Janeiro RJ, Brazil;
2lnstitute of Human Virology Baltimore MD, USA
Issue: The WHO has recommended breast feeding for HIV infected women even
though it is a known risk for transmission of HIV from mother to infant. Alternatives
must be found which do not compromise the infants health.
Project: As part of an "Integrated Program" for the care of HIV infected pregnant women and their children, a multi-disciplinary team of health careworkers in