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

12th World AIDS Conference

Abstracts 60252-60257 1045

60252 Preliminary results of antiviral effect of double and triple
drug combination therapy
Jacek Gasiorowski, M. Zalewska, B. Knysz, M. Inglot, A. Gladysz. Department
of Infectious Disease, Wroclaw, Poland
The objective of the study was the evaluation of the efficacy of double and triple
drug antiviral therapy among HIV infected patients (pts.) in south-western district
of Poland.
Material: 17 pts. naive for treatment, in the mean age of 28 yrs. were divided
into 2 groups: 1. treated with AZT + ddC (7 pts.), 2. treated with triple combinations: AZT + ddC + SQV HGC (5 pts.), AZT + 3TC + SQV - HGC (3 pts.), d4T
+ 3TC + RTV (2 pts.).
Methods: In all pts. CD4 cell count and viral load (RT-PCR Roche Molecular
Systems) were evaluated twice: before treatment (bt.) and after 3 months (3 m.).
Results: 1st group: mean CD4 count bt. was 362 cells/l/L; after 3 m. 438
cells/pL (increase of 21%). The mean viral load bt. was log 5.34 (4-5.99); after
3 m. log 4.07 (0-4.69). The most decrease was log 4.04. Two pts. achieved a
reduction to below detection. All the pts. were considered compliant. 2nd group:
mean CD4 count bt. was 122 cells//iL; after 3 m. 171 cells/iL (increase of 39%).
The mean viral load bt was log 5.91 (3.07-6.74); after 3 m. log 5.53 (0-6.30). The
most decrease was log 4.55. Four pts. achieved a reduction to below detection.
6 pts. in this group were considered compliant.
The therapy was well tolerated. No clinical progression and death was recorded
during the study.
Conclusions: We recorded very high viral load bt. in all the pts. There were no
significant differences in efficacy of both regimens. The results observed in 2nd
group could be influenced by insufficient adherence of pts.
60253 Using registry data to estimate trends in survival after
AIDS diagnosis in Switzerland, diagnosed between 1988
and 1992
Marcel Zwahlen1, B.E. Neuenschwander2, D. Vlahov3, R. Brookmeyer3.
'Federal Office of Public Health, PO Box Ch-3003 Bern; 2University of Bern,
Social Prev. Medici., Bern, Switzerland; 3Johns Hopkins School of Public Health,
Baltimore, MD, USA
Objectives: To assess trends in survival after AIDS diagnosis in Switzerland for
the years 1988 to 1992.
Design: Analysis of a non-concurrent cohort including a subcohort of cases
ascertained after death.
Methods: Since 1988, AIDS is notifiable in Switzerland. Until 1994, 2588
AIDS cases (diagnosed 1988-1992) were anonymously reported to the Swiss
AIDS registry in the three patient groups (40.1% MSM, 44.1% IDU's, 15.6%
heterosexual cases). Death through the end of 1994 was ascertained through
the national data base of death certificates. In addition to the regular reports after
an AIDS diagnosis, the study included 571 (22.1%) cases which were reported
after notification of death (death certificate (DC) subgroup) for which the AIDS
diagnoses were ascertained retrospectively (right truncated survival times). The
statistical analysis was done by a Bayesian multivariate logit model based on
discrete 3-months death hazards.
Results: Overall, 85.0% of the 2588 cases were known to have died by the end
of 1994. From 1988 to 1992, estimated 1-year survival after AIDS for regularly
reported cases (non-DC subgroup) decreased slightly for all patient groups (e.g.,
after pneumocystis carinii pneumonia (PCP) for MSM: 69.8% to 64.3%; IDU's:
71.9% to 66.6%; heterosexuals: 72.9% to 67.8%). Even when accounting for
right truncation, the DC subgroup showed a lower 1-year survival and a similar
decrease (after PCP for MSM: 38.7% to 31.8%; IDU's: 41.5% to 34.6%; heterosexuals: 43.1% to 36.1%). Compared to PCP as the AIDS defining illness,
better survival was estimated for Kaposi's sarcoma (KS) (hazard odds ratio (OR)
= 0.86 with 95% credibility interval [0.76-1.0]), candida esophagus (OR = 0.75,
[0.65-0.87]) and HIV wasting syndrome (OR = 0.84, [0.71-1.0]), and poorer
survival for other cancers than KS (OR = 1.7, [1.3-2.2]) and toxoplasmosis of the
brain (OR = 1.1, [0.97-1.4]).
Conclusions: From 1988 to 1992, survival after AIDS diagnosis decreased
slightly in Switzerland, paralleling a slight decrease of median CD4 count at
diagnosis (data not shown). Survival of AIDS cases detected after death differed markedly from that of cases reported directly after AIDS diagnosis was
established. As right truncation of retrospectively ascertained cases precludes
a standard survival analysis, registries which enhance reporting completeness
through death certificates will have to address this methodological issue.
60254 Are high-frequency amphetamine injectors at elevated
risk for HIV? Results from a US multisite sample
Robert Freeman, M.L. Williams. Nova Research Company 4600 East-West
Highway Bethesda MD (20814), USA
Objectives: This study identifies demographic and behavioral factors associated

with daily injection of amphetamine among US injection drug users (IDUs) in an
attempt to determine whether high-frequency amphetamine injection is associated
with elevated HIV risk.
Methods: This report is based on self-reported data gathered in interviews with
a US national sample of 13,215 not-in-treatment IDUs interviewed in 10 cities
between 1988 and 1992.
Results: Slightly over 2 percent of the sample reported daily amphetamine
injection. These IDUs tended to be male, Caucasian, 26-35 years of age, with

less than a high school education, and living in the western region of the US
51% of these IDUs also were injecting cocaine every day; about 9% injected
amphetamines exclusively. Among the 61.5% tested for HIV-antibody, slightly
under 5% were HIV-positive. In logistic regression, 17 variables were retained
as independent predictors of daily amphetamine injection, including: Caucasian
race; >5 years of drug injection experience; no drug treatment experience in
past 5 years; daily noninjected amphetamine use; daily barbiturate use; daily
marijuana use; any PCP use in last six months; daily injected cocaine use; no
current injected heroin use; injecting all drugs -4 times per day; predominantly
injecting in abandoned buildings; predominantly injecting at a friends' place; sharing needles with a sex partner; any injection at social gatherings in last 6 months;
having >5 sexual partners in last 6 months; poor self-perceived health; and study
recruitment at a western US site. The strongest predictors of daily amphetamine
injection were daily noninjected amphetamine use, western recruitment site, daily
barbiturate use, and current PCP use.
Conclusions: While high-frequency amphetamine injectors are not distinguishable from other IDUs on most dimensions of HIV-related injection risk, they do
appear to be at elevated HIV risk due to frequent injection, frequent injection in
abandoned buildings, and needle sharing with sex partners. As daily injection
of amphetamines also was associated with no current injected heroin use, such
injectors may remain different enough from heroin and cocaine injectors to require
special HIV prevention efforts.
S60255 Apoptotic activity of nitric oxide in HIV-1-infected cells
Donato Torre1, G. Ferrario1, M. Airolai1, A. Pugliese2, C. Cantamessa2,
F. Martini1. Division of Infectious Diseases Viale Borri, Varese; 2stitute of
Infectious Diseases, Varese,
Objectives: The inappropriate induction of apoptosis has been proposed as a
mechanism to explain CD4 lymphocyte depletion in HIV-1 disease. Recently,
we showed increased production of nitric oxide (NO) from PBMC and polymorphonuclear leukocytes of AIDS patients, particularly in those patients with
opportunistic infections. Moreover, it has been demonstrated that the induction of
NO synthase in macrophages results in apoptotic death of these cells. NO donors
are biochemical tools to investigate apoptotic cell death irrespective to NO synthase involvement. The aim of this study is to investigate induction of apoptosis
by NO donor (S-nitrosoacetyl-penicillamine, SNAP) in human peripheral blood
lymphocytes and in H-9 T cells infected with HIV-1.
Methods: The level of apoptotic cells in cultures was determined using the
TUNEL assay, and staining of cells with propidium iodide, and quantified by flow
cytometry.
Results: SNAP induced a significant apoptotic activity in cultured non
HIV-1-infected cells for 24 h, especially at concentrations of 0.5 and 0.1 mg/mL.
In addition, when SNAP was incubated with HIV-1-infected cells, a significant
apoptotic activity was detected.
On the other hand, when HIV-1-infected cells were incubated with SNAP and
with an inhibitor of NO synthase (N-MMLA) no inhibition of apoptotic activity was
noted.
Conclusion: NO synthase seems to be not involved in the apoptotic activity of SNAP on HIV-1-infected cells. The increased production of NO could be
one of the mechanisms responsible for the increased sensitivity of lymphocytes
to undergoing apoptosis in HIV-1 infection. NO as well as tat protein and gp
120 may accelerate Fas-mediated, activation-induced T-cell apoptosis, therefore
contributing to CD4 T-cell depletion.
60256 Changing role of home care nursing in care for people
living with HIV/AIDS
Kit Yee Xanthe Wong, Lesley Ann Sinclair. The Society for AIDS Care, Unit 18A
Winning Centre, 46-48 Wyndham Street Central, Hong Kong (China)
Issue: With Advancement of drugs, care for PHAs (People with HIV/AIDS) is
shifting more towards home based care. This creates demands for better home
based services and facilities beyond the scope of traditional nursing practice.
Project: In Hong Kong, community based care services for PHAs are inadequate and scattered. To address this issue, a special team of Home Care Nurses
was organized in 1995. A retrospective review is being carried out to identify the
changing role of nursing care for PHAs. The services offered are extensive and
varying. Interaction with PHAs takes place in formal and informal settings such
as homes, restaurants, and clinics.
Results: The role of Home Care Nurses is increasingly being identified as a
patient centered support network manager. A list of roles played by the Home
Care Nurses is identified.
Lessons Learned: Regular review of community nursing services is an effective tool to identify and monitor the changing roles of the community nurses in
offering services to PHAs.

S60257 HIV infection among individuals from North African
attending a HIV reference center in Rome
Mauro Zaccarelli1, L. Spizzichino2, S. Venezia2, P. Gattari2. 'IRCCS L.
Spallanzani via Portuense 292 00149 Rome; 2AIDS Unit Asl Rme, Italy
Objective: To analyze the HIV related risk behaviour in a group of individuals
from North Africa who attended a HIV testing facility in Rome.
Study Design: Cross-sectional study.