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

1042 Abstracts 60235-60240

12th World AIDS Conference

60235 CD4 marker of immune restoration in associated
treatment ZDV-DDC (Retrovir-Hivid) in adult HIV(
naive patients
Gabriel Colton, 1. Dumitrache. Hosp. of Inf. Dis. Colentina, 4 Deleni S
opp 28 Bucharest 72236, Romania
Background: Because lack of determination of viral load, in Roman
addition with the total number of limphocytes) is the major parameter to
ered in the follow-up of the antiretroviral treatment. In order to avoid d
clinical events, CD4 must be preserved higher than 200/mm3. Now,
therapy makes it possible.
Patients and Method: We have studied 30 adult naive HIV/AIDS p,
CD4 < 300/mm3 in treatment with ZDV (Retrovir) 600 mg/day (200m
DDC (Hivid) 2.25 mg/day (0.75 mg x 3). For 17 patients CD4 was
at the begining of the treatment, after two weeks, then monthly, for
For other 13 patients, recently included in the study, CD4 was determ
begining of the treatment and after two weeks.
Results:

I antiviral
+)/AIDS
t BL T65
ia, CD4 (in
Sbe considlefavorable
associated
atients with
g x 3) and
determined
6 months.
lined at the?rm treatment
ks-1 month)
134
6
410

Associated therapy ZDV-DDC
CD4 med increase
CD4 min increase
CD4 min increase

Long-term treatment months)
(6 months)
180
2
635

Short-te
(2 wee

Conclusions: In associated therapy ZDV - DDC the antiviral effect is both fast
in short term treatment (2 weeks-1 month) and long lasting in long term treatment
(6 months). From immunological point of view this effect could be evaluated by a
relevant increasement of CD4 and its mentenance at a high lavel which cannot
allow the occurance of clinical major defavorable events.
60236 Sex gender and power: Young women's sexuality in the
shadow of AIDS
Remi Agbomoniyi. Health Matters Inc., Block 1 Suites 3&4, LSDPC Building,
Esther Osiyemi St., Ilupeju, Nigeria
Objectives: (1) To review existing strategies for reaching commercial sex workers
(CSWs); (2) To introduce training skills into curriculum for CSWs; (3) To draw-up
a guideline for CSWs project implementation.
Methods: A dialogue session with NGO leaders focused on strategies to improve the implementation of CSWs projects. The methodology was based on
dialogue and discussion. The method was also aimed at collecting data to probe
participants thinking about this method of reaching CSWs in their various projects.
There was role play on Transactional Analysis (TA) to raise awareness on the different roles people assume when they talk to each other and how the roles could
aid or impede communication with CSWs, and between CSWs and their clients.
Results: Expected outcomes were empowerment of CSWs with decision and
communication skills necessary to project themselves from HIV/AIDS and STDs;
and to initiate effort at controlling heterosexual transmission of HIV/AIDS and
STDs.
The Role of women in control and prevention of HIV/STIs infections is extremely
important and NGOs have important role to pay especially in developing countries
as regards education among the poorly educated.
602371 Use of monitored CD4 cell counts: Predictions of the
AIDS epidemic in Bulgaria
Velislava Terzieva, Sevdalina Raleva, V. Georgieva, D.A. Beshkov, L. Froloshka,
R.K. Markova, R.M. Argirova. 44 A Stoletov Str., Sofia 1233, National AIDS
Reference Laboratory, Bulgaria
Background: Bulgaria is a reportedly low HIV-1 prevalence country (218 HIV+,
100 AIDS cases notified by Dec. 1997, 49 out of them deceased) with predominantly heterosexual transmission. In 1992 a new legislation was introduced
replacing mandatory to voluntary HIV testing. First CD4 cell counts (within 3
months of HIV-diagnosis) complement newly established HIV-1 infections since
mid. 1993. We describe the CD4 database obtained in the Nat. AIDS Ref. Lab.
(Sofia, Bulgaria 1993-1997) and its uses and limitations for making short-term
predictions of a CD4 cell count <200 x 106/1 (CD4200) and of adult AIDS cases.
Design: Prospective, ongoing study.
Methods: Analysis of CD4 cell counts (by Capcellia test of S.D. Pasteur -
until end 1994 and Becton Dickinson FACSCount system after that) of newly
established HIV-1 seropositives. CD4 database at 31 Dec. 1997 listed 169 survived HIV+ persons (15 reported AIDS cases, 3 out of them deceased versus
CD4200/AIDS - 29 during 1993-97 resp.).
Results: Median CD4 count in 1994 for 48 of the diagnosed prevalent HIVinfections was around 200 as was median first CD4 count for newly diagnosed
cases in 1993-94: a pattern broadly consistent with recent diagnoses being
predominantly historical rather than recent HIV-infections. In 1995 9/17 (53%), in
1996 - 3/18 (17%) and in 1997 - 12/28 (43%) were CD4200/AIDS cases, AIDS
cases reported resp. 4, 3 and 5.
Conclusion: We conclude that there are probably more than twice as many
CD4200/AIDS cases as there are AIDS diagnoses. Although low HIV-seroprevalence in Bulgaria the number of CD4200/AIDS cases are increasing suggesting
that recent HIV diagnoses express not recent but longer established infections
due mainly to shift in legislation.

60238 1 Effects of antiretroviral therapy with zidovudine (ZDV) +
lamivudine (3TC) in HIV-1 infected people in Bulgaria
Roumiana Markova1, V.I. Terzieva1, M.T. Polianoval, S.H. Raleva1, P. Ratchev2,
I. Dikov2, R.M. Argirova'. 144A Stoletov Str, Sofia Natl. Ref AIDS Laboratory;
2Medical University Dept. Inf. Diseases, Bulgaria
Objectives: To evaluate the virologic and immunologic efficacy of ZDV/3TC
combination in antiretroviral naive or zidovudin-experienced HIV patients.
Design: Prospective, ongoing study.
Methods: 15 HIV-1 infected adults (9 of them ZDV-experienced) with CD4
counts ranged 30-370/Lj and HIV RNA copies 1000-100 000 as base line, were
given ZDV/3TC for 24 weeks and followed-up at one month's intervals. Viral load
was assessed in plasma (RT-PCR, Monitor - Roche) and immunologic recovery
was evaluated in lymphocyte subsets (FACS analysis), markers of activation
and lymphocyte function. MT2 cell line was used for phenotyping of HIV NSI/SI
variants.
Results: In ZDV-naive patients a sustained increase of mean 78//IL CD4
counts and a decrease (mean 2.7 log) in HIV RNA were demonstrated after 6
months of treatment. In ZDV-experienced patients the same values respectively
were: 58//uL and 1.86 log. In both groups of patients influenced by therapy (6/6
ZDV-naive and 7/9 ZDV-experienced) an improved lymphocyte function (in vitro
response to PHA, rlL-2 and HIV-1 derived antigen) as well as low degree of cell
activation were observed. None of these patients moved to SI phenotype. In all
patients where SI phenotype was found before therapy a shift to NSI has been
registered at the end of treatment.
Conclusion: Zidovudine + lamivudine therapy is affordable in Bulgaria since
1997. So far all patients (especially ZDV-naive) responded to it. This first clinical
and laboratory beneficial of double therapy in our country made us to recommend
it preferable to public health services.
60239 Current situation and recent trends of HIV/AIDS epidemic
in the Republic of Armenia
Lev Zohrabyan1, N.A. Sargsyan2, K.L. Nahapetyan2, N.A. Armaganyan2
M.H. Manrikyan3, S.G. Topchyan4. 1Director of National AIDS Centre, 7 K.
Parbetsi Street Yerevan 375002; 2National AIDS Centre Yerevan; 3Ministry of
Health, Yerevan; 4UNFDA, Officer, Yerevan, Armenia
From august 1987 to december 1993, an ongoing test was carried out in Armenia.
As a result, 3 cases of seropositivity were reported. From early 1994 to May 1996
no case of seropositivity have been detected. From June 1996 to December 1997,
60 new cases of seropositivity have been reported. Thus, as of 31 December
1997, the cumulative number of HIV infected subjects is 63. Number of AIDS
cases is 12; 6 of AIDS patients died of this disease. As in many other countries,
these figures seem to be grossly undereported. 48 of seropositive persons were
adult males and 15 were females; mean age of HIV-infected persons is 31.0
years. Possible modes of HIV transmission include: contaminated needles during
intravenous drug injections (31 cases), heterosexual intercourse (21), homosexual intercourse (1), unknown (10). Many HIV infection cases have been imported
into Armenia from abroad: 1 from Yemen, 1 from Nigeria, 6 from the Russian
Federation, 6 from Ukraine, 1 from Belorussia and 1 from Azerbaijan.
Conclusion: The data presented stress the necessity and urgency of the
preventive int4rventions targetted to restrain the spread of HIV/AIDS epidemic in
Armenia.
60240 A three-year qualitative assessment of Youth response to
HIV and AIDS activities in Kabarole, Uganda
Stephen Sebuddel, R.G. Kabagambe2, D. Ndungutse3, N. Mboma4, K. Walter5.
'Institute of Public Health Makerere University PO BOX 7062 Kampala; 2District
Medical Officer Kabarole Fort-Portal; 3Lecturer Makerere University IPH
Kampala; 4Statistician Institute of Public Health Kampala; 5Lecturer University of
Albert A Dept of PHSC, Uganda
Objective: To improve on community participation in HIV and AIDS Control activities within Kabarole District in order to limit its spread especially among the
youths.
Design: Retrospective, Descriptive cross-sectional survey.
Methods: Two rural, one semi-urban and one urban communities were purposively selected by the District Health Management Team. Participatory Rural
Appraisal Methods of data collection were used. Specifically Focus group Discussions and social mapping. The study population included youths between 15-25
years. Youth leaders, Headmasters, Directors of Projects targeting the youths
and community based organizations were included as Key informants.
Results: A total of 160 youths and 16 key informants were involved in the
study. The perceived ages affected most were between 15 to 30 years. A decline
in HIV and AIDS community activities was noticed between 1993 and 1996.
Condom use and accessibility was noted as a problem. The community preferred
practical methods like Drama of conveying HIV and AIDS messages. There was
an observed uncoordinated organization of seminars and workshops on HIV

and AIDS targeting similar groups of people. Among the community leaders, the
local councilors were left out in the main stream struggle against HIV and AIDS.
Community resources are not yet fully mobilized for HIV and AIDS activities.
Conclusions: Practical methods of conveying HIV and AIDS messages seem
to be more acceptable in limiting the spread of HIV and AIDS. The District Health
Team should involve the communities more in planning for HIV and AIDS actives.